Payment Arrangement Form

"*" indicates required fields

In order to postpone payment for a later date and/or arrange to pay your account on a different payment schedule, this form must be completed 2 WEEKS BEFORE payment is due. Failure to comply will automatically remove your request from consideration. If you are not approved before payment is due, you are still responsible for paying all fees on time.

Please note:

THERE ARE A MAXIMUM OF TWO REQUESTS PERMITTED FOR THE SEASON.

Thank you for your cooperation and understanding.

Name*

First Last

Email*

Phone*

Have You Received A Fee Waiver Before?*

Yes

No

If Yes, Please Specify Fee Type And Date*

Which payment are you requesting arrangements for?

Fee Amount*

Fee Due Date*

Please Revise My Payment Date To The Following*

(must be within the same month)

One Payment

Two Payments

Revised Payment Date*

Revised Payment Date #2*

Additional Comments/Requests:

Signature*