Fillable Payment Plan Promissory Note (Mat-Su College)

Fill Online, Printable, Fillable, Blank Payment Plan Promissory Note (Mat-Su College) Form

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

Payment Plan Promissory Note (Mat-Su College)

On average this form takes 13 minutes to complete

The Payment Plan Promissory Note (Mat-Su College) form is 2 pages long and contains:

  • 0 signatures
  • 3 check-boxes
  • 52 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Mat-Su College

BROWSE MAT-SU 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
 
Page 1 of 2
Payment Plan Promissory Note
SEMESTER: Spring Summer Fall 20___
Student ID# _______________________________
Name: ____________________________________
Last First MI
Mailing Address: ___________________________
__________________________________________
Phone Number: ____________________________
Date of Birth: ______________________________
Driver’s License #: __________________________
SSN: _____________________________________
Previous Name(s): __________________________
Email: ____________________________________
Employment Information
Most Recent Employer: ______________________
Address: __________________________________
Position: __________________________________
Phone: ___________________________________
Please fill out Spouse or Parent. If not available, please provide a third reference.
Spouse Name: _____________________________
Address: __________________________________
City, State, Zip: ____________________________
Current Phone: _____________________________
Parent Name: ______________________________
Address: __________________________________
City, State, Zip: ____________________________
Current Phone: _____________________________
Please fill out BOTH References
Reference Name: ___________________________
Current Phone: _____________________________
Reference Name: ___________________________
Current Phone: ____________________________
Account Balance and Payment Schedule
Total Account Balance: $_____________________
Payment Amount Scheduled payment date
$_________________ ____________________
$_________________ ____________________
$_________________ ____________________
Please indicate if you would like a reminder
Email
Phone
None
$_________________ ____________________
$_________________ ____________________
$_________________ ____________________
$_________________ ____________________
$_________________ ____________________
Student Initials: _________
Administrative Services
8295 E College Dr • Palmer AK 99645
Page 2 of 2
Payment Plan Promissory Note
Name: ____________________________ Student ID#: _______________________
I authorize UAA/MSC to make whatever inquiries it deems necessary in connection with the
review of information concerning my ability to make payments. I understand that any tuition
and fees charged to a payment plan for the current semester are my responsibility. If I default on
a payment plan or my financial aid fails to pay, I will be responsible for the total amount due. I
understand that if I default on this plan I may be sent to a collection agency and agree to
reimburse UAA/MSC the fees of any collection agency, which may be based on a percentage at
a maximum of 40% of the debt, and all costs and expenses, including reasonable attorney's fee
that we incur in such collection efforts. Past due debt may be reported to a local credit bureau.
_____Student Initials
I recognize this as a debt that must be repaid. I agree to pay the amount of the debt stated on the
front of this note in installment payments on or before the due dates specified for each
installment. I understand that installments may change over time to account for any new
charges, payments or financial aid adjustments. _____ Student Initials
I understand that a hold may be placed on my account restricting my ability to register for
cl
asses anywhere in the University of Alaska system and will remain on the account until the
balance is paid in full. _____ Student Initials
I understand that the University may garnish my Permanent Fund Dividend under Alaska
Statutes 14.40.251 and 43.23.190, regardless of payment plan status. _____ Student Initials
I agree to the payment plan installments as outlined within this Promissory Note.
Student Signature: _________________________________
Date: ______________
Email signed scanned copy to msc.campus.cache@alaska.edu
Or
Submit signed paper document to Mat-Su College Campus Cache JKB 109 or mail to:
Mat-Su College Campus Cache
8295 E College Dr
P
almer AK 99645
Questions? Please contact the Mat-Su College Campus Cache at 907-745-9739
Administrative Services
8295 E College Dr • Palmer AK 99645
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

Payment Plan Promissory Note (Mat-Su College)

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 30 January 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document