FACTS E-Cashier Payment Agreement

2016-2017 FACTS Tuition Payment Agreement

FACTS Management Company and its subsidiaries provide a payment program for schools across the country. Because FACTS is not a loan program, there is no debt incurred and no credit search. There are no interest or finance charges assessed by FACTS on the unpaid balance.

Enrollment Fee: The nonrefundable FACTS Enrollment Fee to budget payment(s) through FACTS is $45.00 per school year. This fee will be automatically processed within 14 days of the agreement being completed by Our Lady’s School and posted to the FACTS system. * These fields are required to complete Agreement.

Student Information:

* First Name ______* Last Name ______

* First Name ______* Last Name ______* First Name ______* Last Name ______* First Name ______* Last Name ______* First Name ______* Last Name ______

Responsible Person for Payment:

* First Name ______* Last Name ______

* Address ______* City ______* State ______* Zip ______

* Phone Number ______* Cell Phone Number ______

* Email ______

FACTS ID & Password: Your FACTS ID will be the email you provided above. Your FACTS Password must be 8-10 characters long, alpha and/or numeric letters. You are required to verify your FACTS Password when calling or viewing account information online through My FACTS Account at www.factsmgt.com.

* FACTS Password: ______

Additional Authorized Party (Optional): The Responsible Party names the person listed below as an Additional Authorized Party, who may inquire about all account information and make changes to the account on behalf of the Responsible Party. The Responsibility Party agrees that the Additional Authorized Party may take any action with reference to the account as could be taken by the Responsible Party, except changing the name of the Additional Authorized Party or FACTS Access Code. The Responsible Party agrees to be bound by any actions taken by the Additional Authorized Party pursuant to the authority herby granted.

Additional Authorized Party: ______

FACTS Peace of Mind Benefit: The Peace of Mind benefit will pay any FACTS unpaid balance (except payments in arrears) in the event of the death of the Responsible Party who has entered into this agreement or his/her legal spouse. Coverage does not apply when cancer or complications related to cancer cause death, and the individual has received or been advised to receive medical advice, diagnosis, or treatment for cancer at the time coverage begins. Additional information on Peace of Mind is provided in the terms and conditions. The nonrefundable annual fee for this benefit is $12 per FACTS agreement. If you elect to enroll, the Peace of Mind fee will be added to your FACTS Enrollment Fee. If applicable, you will be automatically reenrolled in the Peace of Mind plan each consecutive year you have a FACTS Automatic Tuition Payment Agreement. ___ Yes, please enroll me in the FACTS Peace of Mind Protection Plan. ***Continues on Back***

Payments: The standard 10 month Tuition Schedule is August-May. If you choose the 12 month plan, there is a 1.5% service charge on balance. OLS is also offering the option to have the following fees added to your total tuition balance: Maintenance/Technology, Workbooks, Building Fund Assessment, Food Services, & Aftercare.

Please check the appropriate boxes below:

_____ 10 month plan _____ 12 month plan with 1.5% Service Charge on total.

_____ Yes, please add these Fees to my Tuition Total:

Maintenance/Technology _____ Workbooks ______Food Services _____

Building Fund Assessment _____ Aftercare _____

_____ No, I do not wish to have Fees added to my Tuition.

Choose the date you wish to have your payment made:

_____ 5th of the month _____ 20th of the month

** Bi-monthly payments are also available. Just check both days. **

Bank Information (United States Bank Accounts Only)

* Bank Name ______* City ______* State ______

* Bank Routing Number ______* Bank Account Number ______

* Account Type: ______Checking ______Savings

All information on this document will remain confidential. ======For Office Use Only

Date Rec’d:______By: ______Date Completed on FACTS: ______By: ______