Payment Option Form and Promissory Note
for School of Education Site Based Education Centers
Spring Semester – January 2015 start
Please complete this form and return to:
FAX number: (509) 313-6399
Mary Beth Charleboix
Student Accounts
PO Box 3463, Spokane WA 99220
Email: [email protected]
Student Name: ____________________________________ Student ID #: _____________________________
Address: _________________________________________City/State/Zip: ___________________________
Home phone: (____) ____________ Work phone: (____) ___________ Off Campus Cohort Name: _____________
All electronic bills will be sent to the student’s official Gonzaga University email address.
All payments to Gonzaga University must be made in United States funds.
Please note that the “No Payment / No Arrangement” fee is 3% of total charges.
Your registration may be cancelled if payment is not received by January 19, 2015.
_____
OPTION 1: Spring Semester charges - CHECK PAYMENT IN FULL - Due: January 19, 2015. Please include a note
with the student’s name and student identification number in the payment envelope when mailing a check to our office.
_____
OPTION 2: Spring Semester charges - ONLINE CREDIT CARD PAYMENT IN FULL VIA CASHNet®
Due: January 19, 2015. Students please log on to http://zagweb.gonzaga.edu. A service fee of 2.75% will be charged per
transaction. American Express, Discover, MasterCard and Visa are accepted.
_____
OPTION 3: Spring Semester charges - FOUR MONTHLY PAYMENTS – There is a $ 25.00 financing fee charged in
addition to tuition/fees. I will pay my balance due each month as outlined below:
Due Dates: January 19, 2015 (total amount financed divided by 4) plus $ 25.00
= $________________
And February 19, 2015 (total amount financed divided by 4)
= $ ________________
And March 19, 2015 (total amount financed divided by 4)
= $ ________________
And April 19, 2015 (total amount financed divided by 4)
= $ ________________
..............................................................................................
Late payments are subject to a 3% late charge, and monthly finance charges of 1% (12% per annum). Online credit card
payments may be made via CASHNet. Please log on to http://zagweb.gonzaga.edu. A service fee of 2.75% will be charged per
transaction. American Express, Discover, MasterCard and Visa are accepted.
_____
OPTION 4: UNITED STATES GUARANTEED STUDENT LOAN(S) will pay my balance in full by the deadline of
January 19, 2015.
I acknowledge that I must already be awarded spring semester financial aid to select this option;
otherwise I must select option 1, 2, or 3 as listed above. If my student loan is not credited to my
student account by January 19, 2015, a 30-day deferral period will be granted for a $25.00 deferral fee.
If the "Total Amount Financed" is not received by February 19, 2015, a 3% late charge and monthly
finance charges of 1% (12% per annum pro rata) will be assessed. Loans that are sent to Gonzaga in
check form (not electronic funds transfer) will be mailed for my endorsement to the address indicated above.
My signature verifies that I have read & agree to the payment terms outlined on pages one and two of this payment
option form.
Signature ______________________________________________________ Date___________________
COMPLETE AND RETURN THIS FORM BY MONDAY, JANUARY 19, 2015.
Page 1
Fee/Code: FOCS $25.00
Spring Semester 2015
Instructions for Gonzaga University Students
SCHOOL OF EDUCATION Site-Based Education Programs
Please note that your housing charges may not be included in this billing statement. Please contact Student Accounts for information
regarding payment for Gonzaga University housing. Paid deposit information will also be verified by your Student Accounts representative.
Available payment options are on the reverse. The "Total Amount Financed" is equal to the "Total Due" on the enclosed billing
invoice.
Initial your chosen payment option then sign and date the bottom of the form. Please return this form with your check payment to Student
Accounts – Gonzaga University so that it is received (not postmarked) by January 19, 2015.
Online credit card payments may be made via CASHNet®. Please log on to http://zagweb.gonzaga.edu. American Express, Discover,
MasterCard and Visa cards are accepted. A service fee of 2.75% will be charged per transaction.
You should allow sufficient mailing time for check payments. Your professor has been asked not to accept and/or deliver payments on your
behalf. Please do not attempt to send a payment with your instructor and kindly understand the professor’s position when he or she refuses
your request.
If your student account balance is to be paid by a corporate or foreign sponsor, a government agency, a religious institution, a scholarship
foundation or a trust account, we require proof of sponsorship in the Student Accounts Office to confirm your classes by January 19, 2015.
Your registration may be cancelled if payment is not received by January 19, 2015.
Please contact Mary Beth Charleboix, Student Accounts, if you have questions.
Phone: (509) 313-6817 or 1-800-440-5392, ext. 6817
Fax: (509) 313-6399
Email address: [email protected]
Campus Location: Room 018 West in College Hall basement
All payments must be made in United States funds. Canadian funds are not
accepted. We do not accept post-dated checks. Checks received in Canadian
funds and/or post-dated checks will be returned to the student. Late fees may
be assessed.
TL11A - Tuition, Education, and Textbook Amounts Certificates
TL11A 2014 Canadian tax receipts will be mailed to students before March 1, 2015. Revenue Canada requires that tuition/fees certificates for
January 1 to December 31, 2014, be issued to full-time, matriculating Canadian students. These documents will be mailed from Gonzaga
University AFTER February 15 but before March 1, 2015.
TL11A documents are not available online. To avoid delays, please keep mailing addresses current in our computer system by
emailing Mary Beth at [email protected] or calling (509)-313-6817.
PAYMENT TERMS : Upon failure to make any payment as due, Gonzaga University or its assignee, may, at its option, declare the entire
unpaid balance due as immediately due and payable, whatever the original scheduled due dates.
If this note is placed for collection the student agrees to pay reasonable collection costs and attorneys fees, and if suit shall be brought to
collect any principal or interest of this note, the student promises to pay a reasonable attorney's fee. Venue shall be in Spokane County,
Washington.
Any fees or charges not included on your billing statement will be due and payable when incurred by the student. A balance owing after the
payment due date will accrue a finance charge at a rate of 12% per annum pro rata (365 days).
Page 2