Education EZRouting Agreement

Education EZRouting Agreement

Student and Responsible Party Information

Student Name:

Date of Birth:     Student ID:

Relationship to Student:     Phone:

Program and Payment Terms

Program Start Date:     Tuition / Fees Due: $

Full payment at time of enrollment     Installment plan     Other:

Monthly     Per term/semester     One-time

Scheduled Debit Day (if applicable):     First Effective Debit Date:

Bank Account Authorization (ACH Debit)

By signing below, the Responsible Party authorizes the Educational Institution to initiate electronic debits to the bank account identified below for payment of tuition and authorized fees. This authorization remains in effect until revoked in writing with the Institution and allows for debits in amounts consistent with the selected payment plan and any adjustments for authorized charges, refunds, or corrections.

Routing Number:     Account Number:

Checking     Savings

Authorizations, Representations, and Acknowledgements

Authorization: The Responsible Party certifies that each financial account identified above is owned or authorized for use by the Responsible Party. The Responsible Party authorizes the Institution to debit such account for amounts due for tuition, fees, and any authorized charges, including late fees and returned item charges, and to credit the account for authorized refunds. This authorization constitutes a standing authorization until revoked as provided herein.

Returned Items and Fees: The Responsible Party agrees to pay a returned item or insufficient funds fee in the amount of for each debit returned by the financial institution. The Institution may attempt one or more re-presentments for collection of any returned item.

Changes and Cancellation: The Responsible Party may revoke this authorization by providing written notice to the Institution at least days prior to the next scheduled debit. Cancellation does not affect the Institution’s right to collect amounts already due or initiate collections for unpaid balances in accordance with institutional policy.

Liability and Indemnification: The Institution will exercise commercially reasonable procedures to process electronic debits, but the Responsible Party acknowledges and accepts that errors may occur. The Institution is not liable for banking delays or errors arising from inaccurate information provided by the Responsible Party. The Responsible Party indemnifies and holds the Institution harmless from claims, losses, or expenses arising from misuse of the authorization or incorrect account information.

Electronic Notices and Communications: The Responsible Party consents to receive billing statements, notices of change, and other communications related to this agreement electronically unless a written request for paper delivery is made. I consent to electronic communications.

Academic Policies Acknowledgment

The Responsible Party acknowledges that continued enrollment is subject to compliance with the Institution’s academic and conduct policies, payment obligations, and collection procedures. Nonpayment may result in administrative holds, suspension of services, or disenrollment in accordance with institutional policy.

Acknowledgement and Signature

By signing below, the Responsible Party authorizes the Institution to initiate debits to the account indicated, represents that all information provided is accurate, and agrees to the terms and conditions set forth in this Education EZRouting Agreement.

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