MORGAN STATE UNIVERSITY
BALTIMORE, MARYLAND 21251
(443) 885-3108
DEFERRED PAYMENT AGREEMENT
Please Print
Date:
Student Name: SS#:
Last First MI
Mailing Address:
Phone:
Parent’s Name:
Phone:
Address:
I am a [ ] dependent student [ ] Independent student
Total Semester Charges $
Deferred Payment Fee $ 25.00
Less: Financial Aid $
F/A Deferment $
Cash Payment $
Amount payable at registration $
Total Credit $
Amount Deferred $
Second Payment $
Date Due
Final Payment $
Date Due
I hereby promise to pay the charge indicated above and make installment payments in accordance with the above schedule. I
understand that if I fail to make payments on the indicated dates that my account will automatically be assessed a $20.00 late fee
for each period.
Failure to respond to University collection efforts will result in the submission of my account to the Central Collection Unit of
Maryland, and I will be subject to pay the collection cost of 17% of the principal outstanding balance.
Student’s Signature Date
Approved by:
Name Date
FOR OFFICE USE ONLY
White - Student Copy Yellow - Billing & Receivables Pink - Parent Gold - File Copy
