Fillable Additional-Dining-Dollars-Request-Form ADDITIONAL DINING DOLLARS REQUEST FORM

Fill Online, Printable, Fillable, Blank Additional-Dining-Dollars-Request-Form ADDITIONAL DINING DOLLARS REQUEST FORM Form

Use Fill to complete blank online DARTON STATE COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Additional-Dining-Dollars-Request-Form ADDITIONAL DINING DOLLARS REQUEST FORM

On average this form takes 3 minutes to complete

The Additional-Dining-Dollars-Request-Form ADDITIONAL DINING DOLLARS REQUEST FORM form is 2 pages long and contains:

  • 0 signatures
  • 9 check-boxes
  • 9 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Darton State College

BROWSE DARTON STATE COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Last Updated: March 2018
ADDITIONAL DINING DOLLARS REQUEST FORM
Instructions: Please complete the form below. Notification will be sent to the student at the email address listed on this form
confirming the additional Dining Dollars Plan has been added to the student account. Return this form to the Meal Plan Office
or submit via email to mealplans@asurams.edu.
Please select the corresponding term session: □ Summer □ Fall □ Spring
Student Information:
Name (please print): _________________________________________ ASU RAM ID: _________________________________
ASU Student E-mail:
___________________________________________________________________________________________________
Dining Dollar Plans: please select one
Pay $150; receive $170 in Dining Dollars
Pay $200; receive $226 in Dining Dollars
Pay $250; receive $283 in Dining Dollars
NOTE: Unused dining dollars will be refunded 30 days from the last day of each semester/term.
PAYMENT INFORMATION:
DINING DOLLAR PLANS MUST BE PAID IN FULL OR HAVE FINANCIAL AID APPROVAL FOR PAYMENT PRIOR TO DINING DOLLAR
ACTIVATION.
Accepted methods of payment for additional dining dollar plans at Albany State are cash, debit card, VISA, MasterCard, money
order, cashier’s check, certified check or by charging to the student’s financial aid account provided available funds have been
verified. Unused dining dollars will be refunded 30 days from the last day of the semester/term. Note:
unused dining dollars will
be refunded at a cost equal to or less than the initial cost of plan, i.e., if the $150 dining dollar plan is chosen, a refund
cannot exceed $150.
ACCEPTANCE OF AND AGREEMENT TO PAY FOR ADDITIONAL DINING DOLLARS PLAN:
I hereby accept the terms and conditions outlined above and authorize the institution to charge the full cost of the additional
dining dollars plan chosen above to my student account for the 2017-2018 Academic Year. I understand that it is my responsibility
to pay the additional dining dollars plan in full or have financial aid approval in order for the dining dollars plan to be activated.
Signature necessary to authorize additional dining dollars plan charge to your university account.
Payment will be made by (please check all that apply):
□
Cash
□
Visa/MasterCard
□
Financial Aid
□
Debit
□
Cashier’s/Certified Check
□
Other
____ Payroll Deduction (Faculty and Staff ONLY; must complete first section of page 3)
Last Updated: March 2018
Signature: _______________________________________________________________ Date: __________________________
Albany State University Payroll Deduction Authorization
Payroll Deduction Acknowledgment: To be completed by the Employee.
I hereby authorize the University to deduct the meal plan costs chosen in this meal plan contract from my paycheck.
Print Name:
Title:
Signature:
Date:
PAYROLL AND AUXILIARY SERVICES PERSONNEL ONLY:
Payroll: To be completed by Payroll Administrator.
Accepted for payroll deduction
Print Name:
Title:
Signature:
Date:
Auxiliary Services ONLY: To be completed by Auxiliary Administrator.
Charged to Banner Account: Date: ________________ Charged by: ___________________________________
Auxiliary Services Title:
Print Name:
Auxiliary Services Signature: Date:
DETAILED PAYROLL DEDUCTION PAYMENTS: To be completed by Auxiliary Services.
Month 1:
_____________
Month 2:
_____________
Month 3:
______________
TOTAL:
_______________
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Additional-Dining-Dollars-Request-Form ADDITIONAL DINING DOLLARS REQUEST FORM

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 28 November 2019

Message

View Audit Log
Print With Audit Log
Duplicate Document