3 Pmt & Financial Resp. Form - stalphonsusbr.org › editoruploads › files › 2021-2022...3_Pmt &...
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Student's Circle One Name 1. New / Returning Student Grade Entering Student's Name 2. New / Returning Student Grade Entering Student's Name 3. New / Returning Student Grade Entering Student's Name 4. New / Returning Student Grade Entering Financial Responsibility: Example: Parents, Grandparents, Guardians, etc. who are responsible. First Name and Last Name Relationship to Student Financial Responsibility First Name and Last Name Relationship to Student Financial Responsibility Payment Options: u Registration Fee: $275 per Student or $550 per Family q Draft account - on 01/15/2021 or q Check attached Note: Registration Fees increase on January 16, 2021 to $325 and on January 25, 2021 to $375. u Student Fees: PK3 & PK4 - $225 K - 8 - $565 q Check attached q Draft account on 05/15/2021 u Tuition: Please check the box(es) that apply to the student(s) listed above. q Payment in Full - draft on 05/15/2021 q Payment in Full - Check (attached, if paying now) q Semi-Annual - draft on 05/15/2021 [Student Fees & 1/2 Tuition] & 11/15/2021 [1/2 Tuition] Tuition drafts are for 10 months - see payment schedule on SAS website for amount of draft q Monthly - draft on the 15th of every month, beginning 06/15/2021 q I have attached a VOIDED CHECK for ACH Draft or a letter from my Bank. SIGNATURE: DATE PAYMENT: Receipt#: q Renweb Date Received: Check#: Amount: Batch No.: q Excel QB: Bank: Office Use Only Notes: St. Alphonsus Catholic School Payment Option Form 2021-2022 % % I authorize St. Alphonsus Catholic School (SAS) to debit my account at the depository financial institution provided by me or I authorize St. Alphonsus Catholic School (SAS) to process the attached check for payment of tuition and fees as indicated. My authorization will remain in effect until I cancel it in writing, and I agree to notify SAS in writing which can be by email of any changes in my account information or termination of this authorization at least 15 days prior to the next draft date . Any returned items for Non Sufficient Funds (NSF) or closed account by my finacial institution, will result in a RETURNED ITEM FEE of $35 and may be processed as a separate transaction. I certify that I am an authorized user of this account and will not dispute the scheduled transactions with my bank; so long as the transactions correspond to the terms indicated in this authorization form. Parent(s) or Guardian(s): Parent(s) or Guardian(s):
Transcript of 3 Pmt & Financial Resp. Form - stalphonsusbr.org › editoruploads › files › 2021-2022...3_Pmt &...
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Student's Circle OneName 1. New / Returning Student Grade Entering
Student'sName 2. New / Returning Student Grade Entering
Student'sName 3. New / Returning Student Grade Entering
Student'sName 4. New / Returning Student Grade Entering
Financial Responsibility: Example: Parents, Grandparents, Guardians, etc. who are responsible.
First Name and Last Name Relationship to Student Financial Responsibility
First Name and Last Name Relationship to Student Financial Responsibility
Payment Options:
u Registration Fee: $275 per Student or $550 per Familyq Draft account - on 01/15/2021 or q Check attached
Note: Registration Fees increase on January 16, 2021 to $325 and on January 25, 2021 to $375.
u Student Fees: PK3 & PK4 - $225 K - 8 - $565q Check attachedq Draft account on 05/15/2021
u Tuition: Please check the box(es) that apply to the student(s) listed above. q Payment in Full - draft on 05/15/2021
q Payment in Full - Check (attached, if paying now)q Semi-Annual - draft on 05/15/2021 [Student Fees & 1/2 Tuition] & 11/15/2021 [1/2 Tuition]
Tuition drafts are for 10 months - see payment schedule on SAS website for amount of draftq Monthly - draft on the 15th of every month, beginning 06/15/2021
q I have attached a VOIDED CHECK for ACH Draft or a letter from my Bank.
SIGNATURE: DATE
PAYMENT: Receipt#: q Renweb
Date Received: Check#: Amount: Batch No.: q Excel
QB: Bank:
Office Use Only
Notes:
St. Alphonsus Catholic SchoolPayment Option Form
2021-2022
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I authorize St. Alphonsus Catholic School (SAS) to debit my account at the depository financial institution provided by me or I authorize St. Alphonsus Catholic School (SAS) to process the attached check for payment of tuition and fees as indicated. My authorization will remain in effect until I cancel it in writing, and I agree to notify SAS in writing which can be by email of any changes in my account information or termination of this authorization at least 15 days prior to the next draft date . Any returned items for Non Sufficient Funds (NSF) or closed account by my finacial institution, will result in a RETURNED ITEM FEE of $35 and may be processed as a separate transaction. I certify that I am an authorized user of this account and will not dispute the scheduled transactions with my bank; so long as the transactions correspond to the terms indicated in this authorization form.
Parent(s) or Guardian(s):
Parent(s) or Guardian(s):
