Niagara University's Payment Plan Application

Please indicate semester or academic year for which you are applying for:

Student Information:
First Name:
Last Name:
Middle Initial:
Student Number: Use numbers only! Ex. 0603838
Social Security Number:
E-mail

 

Financially Responsible Person's Information:
First Name:
Last Name:
Middle Initial:
Relationship to Student:
Social Security Number:
Home Phone:
Date of Birth:
Driver's License Number:
Place of Employment:
Work Phone :
Permanent Address  
Number & Street:
City:
State:
Zip:

 

Automatic Payment Information (VISA, MasterCard, or Discover):
By pressing the submit button below. I agree to have each installment charged to my credit card according to the dates indicated on the payment plan schedule. I understand that I will receive a billing in the mail indicating the amount to be charged and unless I otherwise notify the Student Accounts Office prior to the due date, such charges will be automatically charged to the credit card I have provided.
Cardholder:
Address: (Number only required)
Zip Code:
Credit Card Number:
Exp. Date

I understand that by submitting this online application to Niagara University that I am in knowledge of and will adhere to the following:

Niagara University reserves the rights to review all applications, and approve or deny based upon previous payment record and information provided on the application. No applications will be processed on any student with an outstanding balance from a previous semester.

Upon receipt of application, Niagara University will charge the student account a nonrefundable fee of fifty dollars for participation in this Niagara University Payment Plan for the academic year (Fall/Spring) or a thirty dollar fee for only one semester. This fee entitles the financially responsible individual to five payment installments per semester.

Responsible person agrees to satisfy the total estimated amount due in accordance with the estimated charges and estimated credits as determined by the calculation worksheet. The responsible person understands that the calculation worksheet is only an estimate and that payments are due and payable every month according to the monthly statement of account. The responsible person agrees to pay the debt/debts incurred and charged on the students account throughout a semester although you may not personally receive any property and/or services. You may be sued for payment, and become responsible for any collection/legal costs, although the person who receives or has received the property and/or service is able to pay.

I understand that I will be responsible for a 2% late fee on any installment that is not received by the respective due date. If, as the financially responsible person, I fail to submit two or more payments on time, Niagara University reserves the right to cancel this contract, thus, causing the entire semesters balance to become due immediately.