PAYMENT AGREEMENT FOR TUITION/FEES
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1 PAYMENT AGREEMENT FOR TUITION/FEES Parent Name(s) Date Billing Address Phone Number Address Father's Social Security # Mother's Social Security # Member Rate 1,250 Name Grade Child Number 2 1,000 Name Grade Child Number Name Grade Non-Member 2,500 Name Grade Child Number 2 2,250 Name Grade Child Number 3 2,000 Name Grade Tuition/General Fees TUITION/FEES Registration 300 Kindergarten - Scholastic News 8.00 Technology 100 Grades Scholastic News 7.00 Assembly Fee 10 Grade 2 - All God's People Athletic Fee 50 Grade 4 - Recorder Books 5.00 (If applicable) Grade Band Books Payment Plan Fee 50 Grades Catechism (Unless paying with cash or check) Financial Aid Amount Gifted TOTAL DUE Option 1 Pay in full via any payment method (other than debit). Option 2 Pay over 10 months (August - May) - ACH or credit card on file. Monthly installment of per month payable on the 10th of each month. If 10th is on a weekend/holiday, the charge will be effective on the day prior. Complete Page 2 (echeck Authorization) OR Page 3 (Credit Card Authorization) Option 3 Pay over 6 months (August - January) - Manual pay (check, cash, or credit card) Monthly installment of. Late fees of 1% of the balance due will be assessed for payment recreived (not postmarked) after the 10th of each month. Complete Page 3 if selecting to pay via credit card. CERTIFICATION (Initial Each Box) Grade-Specific and Athletic Fee PAYMENT OPTION PLANS (Initial Preferred Option) I understand and agree that I am responsible for all tuition and fees assessed per this schedule as indicated above. I understand and agree that I am responsible for all fees incurred due to declined credit cards or checks returned from the bank. (Minimum charge is $25.00.) I understand and agree that I am responsible for additional fees should this account go to collections due to non-payment of account. Parent or Guardian - Signature Parent or Guardian - Signature Parent or Guardian - Printed Parent or Guardian - Printed
2 PAGE 2 - echeck AUTHORIZATION FORM I authorize St. Paul Evangelical Lutheran Congregation (aka St. Paul Lutheran Church and School) to initiate either an electronic debit or to create and process a demand draft against my bank account according to the terms outlined below. I acknowldge that the origination of ACH transactions to my account must comply with the provisioning of United States law. Terms of Billing Option 1 Pay in fulll for the amount of. Option 2 Pay over 10 months (August - May) - ACH or credit card. Starting in August and on the 10th day of each month through May, 2020 in the amount of. Bank Information Routing Number: Account Number: Account Type: Checking Savings This payment authorization is to remain in full force and effect until I,, notify St. Paul Lutheran Church and School of its cancellation by sending written notice in such time and in such manner to allow both St. Paul Lutheran Church and School and the receiving financial institution a reasonable opportunity to act on it. I further acknowledge in the event of non-sufficient funds (NSF), I will be liable to resulting NSF fees and billed appropriately. Member Signature Member Printed Name Date Note Once information is entered into your electronic PCI-Compliant account, this form is destroyed. Account information is truncated within your account and cannot be read by anyone within our church or school.
3 PAGE 3 - CREDIT CARD AUTHORIZATION FORM I authorize St. Paul Evangelical Lutheran Congregation (aka St. Paul Lutheran Church and School) to initiate either an electronic debit or to create and process a demand draft against my credit card account according to the terms outlined below. acknowledge that the origination of credit transactions to my account must comply with the provisioning of United States law. Terms of Billing Option 1 Pay in fulll for the amount of. Option 2 Pay over 10 months (August - May) - ACH or credit card. Starting in August and on the 10th day of each month through May, 2020 in the amount of. Credit Card Information (Credit cards only - no debit cards) Card Number Expiration Date CVC Code Billing Zip Code This payment authorization is to remain in full force and effect until I,, notify St. Paul Lutheran Church and School of its cancellation by sending written notice in such time and in such manner to allow both St. Paul Lutheran Church and School and the receiving financial institution a reasonable opportunity to act on it. I further acknowledge in the event of credit card delination, I will be liable for resulting declination fees and billed appropriately. Member Signature Member Printed Name Date Note Once information is entered into your electronic PCI-Compliant account, this form is destroyed. Account information is truncated within your account and cannot be read by anyone within our church or school.
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WhatisTheDifference? The$Difference$is$a$unique$Student$Ministry$event$in$which$several$youth$ groups$in$the$nacogdoches$area$come$together$at$pineywoods$camp$(near$ Corrigan)$to$study$the$truth$and$worship$with$one$another.$$Our$goal$is$that$
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DANCE DIMENSIONS PAC 2015 MASTER CLASS INTENSIVE REGISTRATION 818-999-DANCE (3262) Fax: 818-999-5298 PLEASE FILL OUT COMPLETELY! Today s Date: _ Student s Name (Please print) Age: Date of Birth: Parents