Printable Payment Plan Agreement Form

Print the following form and return the completed form in person or by mail to:

MSOE Student Accounts Office
Room CC-437
1025 North Broadway
Milwaukee, WI 53202-3109

Payment Plan Agreement

(PLEASE PRINT)

Name:

______________________________

Social Security Number:

______________________________

Address:

______________________________

City/State/Zip:

______________________________

Payment Option (Choose one)

Payment in Full	Direct Billing
Financial Aid	Tuition Reimbursement
H.E.L.P. Monthly Payment Plan

My signature indicates that I have read and agree to the terms and conditions of my chosen payment plan and the payment plan agreement. Each person signing this agreement will be obligated to the terms and conditions therein. I understand that my chosen option will remain in effect during my tenure at MSOE. I will contact the Financial Aid Office if changes are necessary.

Signature:

______________________________

Date:

______________________________

MSOE Financial Aid Office
OE Number 003868