The purpose of this form is to document your payment plan option - This form must have school approval
Student Name / Invoice number / description e.g. SRS, Music / Roll class / Invoice amount
1. / $
2. / $
3. / $
4. / $
5. / $
Payment Plan / TOTAL / $
I will make payments by: (Tick Options)
☐ Cash (complete Part A)
☐ Cheque (complete Part A)
☐ EFT (complete part A) - Please phone or email the school’s AR Officer () for Debtor ID/school bank account details
☐ Credit card (complete Part B)
PARENT/CAREGIVER NAME: / PHONE NUMBER:PARENT SIGNATURE: / I am aware that if payments under this plan fall behind, debt recovery action/s will be initiated
?
☐ Centrepay (complete Part C - Contact the office first for Centrepay application form)
/ PAYMENT BY CASH, CHEQUE OR EFT☐ I agree to make regular payments on specific dates listed below until total amount is paid in full.
ð 1st payment will start on ……./……./……. ☐ weekly ☐ fortnightly ☐ monthly
Date of payment / Amount / Office Use only Receipt # & initial / Date of payment / Amount / Office Use only Receipt # & initial
1 / 6
2 / 7
3 / 8
4 / 9
5 / 10
/ PAYMENT BY CREDIT CARD (Direct Debit)
☐ Credit card (Bpoint direct debit) - Please phone or email the school’s AR Officer () for details
I will make ………….. (number of EQUAL payments) ☐ weekly ☐ fortnightly ☐ monthly
1st payment will start on ….…./……./…….
My email address is: ………………………………………………………………………………………
/ PAYMENT BY CENTREPAY
☐ Centrepay * Please phone or email the school’s AR Officer () for Centrepay application form