FINANCIAL AGREEMENT FORM

FINANCIAL AGREEMENT FORM
(I). GENERAL ENROLLMENT REQUIREMENTS:
(A). Payment of Educational Expenses: In order to enroll as a student at the University of WisconsinPlatteville and register for classes at the University of Wisconsin-Platteville, I understand that I am
responsible for payment in full of all educational expenses, including applicable tuition, fees, housing
costs, meal plan costs, and other miscellaneous charges incurred in connection with my registration and
attendance at the University of Wisconsin-Platteville. Such payment must be received in full by the
established due dates set by the University of Wisconsin-Platteville for each term. (To see such due
dates, please visit (http://uwplatt.edu/business/cashiers). In order to complete my enrollment and
registration at the University of Wisconsin-Platteville, I am required to enter into this agreement for the
purpose of clarifying the University of Wisconsin-Platteville requirements in regard to payment for the
University of Wisconsin-Platteville educational services, online account services and other related terms
and conditions which relate to my receipt of educational services from the University of WisconsinPlatteville. I understand that if I am eligible for the payment plan option below, the University of
Wisconsin-Platteville shall have the right to automatically initiate the payment plan option described
below in accordance with these terms and conditions.
(B). Access to Pioneer Administrative Software System (PASS): the University of Wisconsin-Platteville
will provide me with access to an on-line PASS account. Through my PASS account, I will be able to
register for classes, access my grades and class schedule, view billing information and amounts owed to
the University of Wisconsin-Platteville, the due dates for such amounts, and the status of any financial
aid I may be entitled to receive. I agree that I will accept notices on my UW-Platteville email account as
official billing notifications
(C). Payment Plan: Although all eligible educational expense are payable on the relevant Due Date
indicated for such amounts in PASS, the University of Wisconsin-Platteville recognizes that students,
including myself, may not make such payments in full on the relevant Due Dates for each term. At its
discretion and if certain requirements are met, the University of Wisconsin-Platteville would like to
extend credit to me to allow me to pay certain past due amounts pursuant to a payment plan detailed
below (the Payment Plan). Tuition, segregated fees, United Council Fees, miscellaneous fees, housing
and meal plan costs are eligible for placement on the Payment Plan. The Payment Plan will allow me to
make payments in three installments later in the term. Finance charges of 1% monthly (12% APR) will
be applied to any amounts on the Payment Plan. In order to avoid a material breach of this agreement,
all outstanding amounts due and owed must be paid by the due dates indicated on the student account.
Failure to make all payments shall result in the University of Wisconsin-Platteville initiating collection
action as described herein below.
I am being asked to sign this agreement now so that, in the event that I am unable to pay the entire
balance of tuition, segregated fees, United Council Fees, housing and meal plans, and miscellaneous fees
by the Due Date for any term, the University of Wisconsin-Platteville will place any eligible amounts on
the Payment Plan.
The consequence of failure to pay amounts owed by the relevant due dates are outlined in the
provisions below.
(D). Withdrawal Requirement: Should I choose not to remain enrolled in some classes, or at the
University of Wisconsin-Platteville, I understand I have an obligation to complete the drop process for
classes for which I have registered, or I may be charged for them (may not be eligible for a complete
reversal of the charges). If dropping all classes for the term I will complete the withdrawal process as
found on the University of Wisconsin-Platteville's website (http://www.uwplatt.edu/registrar).
II.
TERMS AND CONDITIONS OF AGREEMENT:
By checking the "I accept the Terms and Conditions" option below, I hereby acknowledge, agree and
consent to the following terms and conditions as follows:
(A). Amounts owed, I agree to Pay:
(i). The amount of any and all segregated (seg) fees, tuition, United Council Fee, housing, meal plan,
miscellaneous fess and any other charges related to the University of Wisconsin-Platteville provision of
services to me, assessed by the University of Wisconsin-Platteville and charged to my PASS account.
(ii). Finance charges at a rate of 12% per year (1% per month) on any unpaid amounts from the due date
of each such amount (as indicated in PASS), until such principal amount shall be paid in full; provided,
however, that a finance charge will not be assessed for any amounts placed on the Payment Plan unless
and until any such installment payment becomes past due.
(iii). Any other late charges and collection costs that may become due as provided in this agreement.
(B). Extension of Credit/Payment Plan: In consideration of the extension of credit to me, from time to
time, by the Board of Regents of the University of Wisconsin System, on behalf of the University of
Wisconsin-Platteville, I hereby acknowledge and agree that the University of Wisconsin-Platteville, at its
sole discretion and authority, may initiate the Payment Plan to which I will be responsible for fulfilling in
regard to payment of certain eligible educational expenses by the Due Date for the applicable term, as
detailed below:
(i). At its discretion, the University of Wisconsin-Platteville may place me on the Payment Plan after the
Due Date for the relevant term;
(ii). A non-refundable administrative assessment of $30.00 for Fall and Spring terms; $15.00 for Summer
and Winterim terms, on eligible unpaid charges will be added to my account when I am placed on the
Payment Plan and such fee is due no later than the next billing due date;
(iii). If I do not pay the entire bill by the first due date, I promise to abide by the following billing
schedule for charges incurred for Fall and Spring semesters:
Installment 1: 34% of tuition/fees, room and/or meal charges, and miscellaneous charges due
approximately 4 days after the beginning of each semester.
Installment 2: 33% of tuition/fees, room and/or meal charges, and miscellaneous charges plus finance
charges; due approximately the 5th week of each semester.
Installment 3: 33% of tuition/fees, room and/or meal charges, and miscellaneous charges plus finance
charges; due approximately the 9th week of each semester;
(iv). I promise to pay all collection costs necessary for the pursuit of any amount not paid when due
including, but not limited to, attorney fees and collection agency fees;
(v). I promise to pay a $30 administrative assessment for Fall and Spring semesters if at least 34% of the
semester charges are not paid by the initial bill due date. (If all charges are paid in full before the initial
bill due date, there will be no finance charges.);
(vi). I promise to pay a $15 administrative assessment if 100% of the Summer charges are not paid by
the end of the regular Summer session;
(vii). I promise to pay a $15 administrative assessment for Winterim if 100% of the Winterim charges
are not paid by the first day of Winterim classes;
(viii). Any amounts due and unpaid by any installment due date will accrue finance charges as indicated
in this section from such date (amounts placed on the installment plan will not accrue finance charges
unless and until an installment payment is missed); and
(ix). The University of Wisconsin-Platteville has the right to deny participation in any Payment Plan for
any term without further notice to me.
(C). PASS and Published Fees: I agree to use my PASS account to obtain the most accurate and current
information regarding any amounts owed and due dates, to check that account before each due date,
and to read the on-line published fee information located at the Student Account's website
(http://www.uwplatt.edu/business/cashiers) each term for additional date and payment information.
(D). Late Enrollment and Changes to Classes or Services: I understand that all tuition, fees, United
Council Fees, housing and meal charges, and miscellaneous charges are due on the term due date, even
if I have not received a bill for them. In the event that I enroll in the term after the first billing has been
processed, or make adjustments to my class schedule, housing, or meal plan options, I will check my
PASS account for the current balance due at the term due date.
(E). Course Cancellation & Registration Hold: I understand that my failure to pay any amounts assessed
by the University of Wisconsin-Platteville when due may result in a hold being placed on my registration
and enrollment for future terms.
(F). Restriction of Records: I understand and agree that the University of Wisconsin-Platteville will
restrict the use of my records to prevent my registration and withhold my transcripts in the event I fail
to comply with the payment obligations of this agreement.
(G). Financial Aid: I understand and agree that financial aid awarded to me will be credited to my
student account, and excess funds after all charges are paid will be refunded to me. Any delays in
obtaining financial aid will not exempt me from making payment s when due on my account. Changes in
my credits used for determining aid eligibility may cause the eligibility to be re-calculated and aid to be
deducted from my account. I may have to repay aid previously disbursed to me. I hereby understand,
agree and consent to my student account being charged for any aid overpayment.
(H). Default: I understand and agree that if I fail to make any payment when due, the University of
Wisconsin-Platteville may declare the entire balance of any amounts owed (including principal and
finance charges) to be due and payable within 30 days after giving me notice of such default.
(I). Changes to Terms: The University of Wisconsin-Platteville has the right to unilaterally make changes
affecting the terms of my account, including finance charges to be imposed, by having me sign an
agreement with the updated terms, or by mailing to me at my last known address notice of any such
changes prior to their effective date.
(J). Prepayment: I may pay the remaining balance on my account or more than the minimum payment
at any time to avoid or reduce future finance charges.
(K). Term of Agreement: This agreement is effective as of the date agreed and will continue to be in
effect until a new agreement is signed.
(L). Changes to Contract Information: I agree to inform The University of Wisconsin-Platteville of any
change in my name, address, telephone number, or social security number in a timely manner.
(M). Waiver of Notices, etc: I hereby expressly and severally waive by myself as the debtor, demand or
payment, presentment for payment, notice of dishonor, notice of no-payment, and all other notices
except those required by law, and I further agree that this agreement is controlled by the holding of
Board of Regents of the University of Wisconsin System vs. Mussallem 94 Wis. 2d 657,289 N. W. 2d 8-01
(1980), and that the University of Wisconsin-Platteville may, without notice to myself as the debtor, and
without affecting the liability of myself as the debtor, renew and/or extend this agreement, accept
partial payment thereon, or settle or compromise the amount due or owing.
(N). Release of Information: I am hereby being given notice and give my consent, as may be required by
law, (i) to allow the University of Wisconsin-Platteville at its option, to report favorable and unfavorable
credit information pertaining to myself (i.e. credit ratings, etc) to credit bureaus and other non-campus
third parties and (ii) in the conduct of its credit granting and collection activities, to release my social
security number to these non-campus third parties.
(O). Collection costs & Late Fees: In the event I fail to timely comply with the payment obligations
detailed in this agreement, I agree to pay all costs of collection incurred by the University of Wisconsin-
Platteville including but not limited to collection agency fees, credit bureau fees, legal filing fees, service
of process fees, publication fees, witness fees, reasonable attorney fees and recording fees and to pay
any finance charges assessed by the University of Wisconsin-Platteville. I also understand that the
University of Wisconsin-Platteville may certify my past due balance to the Wisconsin Department of
Revenue and make a claim for the total due against refunds, overpayments, lottery payments or other
assets available to the Department in its collection efforts.
(P). I give permission for The University of Wisconsin-Platteville to contact me at all phone numbers
provided including cell phone numbers. I give express consent to UW-Platteville and/or its
representatives to use an auto-dialer when pursuing collection of my account.
(Q). I agree to the Add/Drop Policy as stated on the link found at The University of WisconsinPlatteville's Registrar's Office website (http://www.uwplatt.edu/registrar/).
(R). I agree to the following Tuition and Fees Refund Schedule:
Spring and Fall: 100% refund weeks 1 and 2; 50% refund weeks 3 and 4.
5 week courses: 100% refund week 1; 50% refund week 2.
6 week courses: 100% refund week 1; 50% refund week 2; 25% refund week 3.
8 week courses: 100% refund week 1; 50% refund week 2; 25% refund week 3.
10 week courses: 100% refund week 1; 50% refund week 2; 25% refund week 3.
Summer-regular session: 100% refund week 1; 50% refund week 2; 25% refund week 3.
Summer-4 week session: 100% refund week 1; 25% refund week 2.
Summer-6 week session: 100% refund week 1; 50% refund week 2.
Summer-Pre-session: 100% refund week 1; 25% refund week 2.
Winterim: 100% refund week 1.
(III). CONSENT TO AGREEMENT/ELECTRONIC SIGNATURE:
(S). By checking "I accept the Terms and conditions" below, I hereby confirm that I have read the
"electronic signature" terms and conditions, I am voluntarily entering into this electronic "Term and
Conditions for Enrollment/Credit Agreement" and I agree to the terms and conditions stated herein
above. I hereby consent to the use of this electronic format and my electronic signature (by checking "I
accept the Terms & Conditions" below) to enter into this agreement. I Accept and understand the legal
enforcement and consequences thereof. I also hereby confirm that I have read and understand the
terms of this agreement.
Signature:_____________________________________Date_______________
WISCONSIN MARITAL PROPERTY ACT SUPPLEMENTAL
The Wisconsin Marital Property Act details the way creditors must deal with married applicants for all forms of
credit. Specifically, we are required to determine if the credit applicant is married. If the applicant is married and a
Wisconsin resident, or a married non-resident maintaining a household in Wisconsin the applicant must provide the
name and address of the spouse. We are then required to notify the spouse of the extension of credit. No provision of
a martial property agreement, a unilateral statement unser s.766.59 Wisconsin Statues or a court decree undr s.766.7
Wisconsin Statues adversely affects the interest of the lender unless the lender, prior to the credit being granted, is
furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the
obligation to the Lender is incurred. If you wish to have a marital property agreement, unilateral statement or court
decree considered in connection with you credit application, you may do so by sending such documents to:
UW-Platteville
Cashier's Office: Brigham Hall
Platteville, WI. 53818
Marital Status
___ Married ___ Single ___ Legally Separated (date of decree of legal separation ___________
Residence
___ Wisconsin Resident
___ Non-Resident
___ Although a non-resident, I do maintain a residence in Wisconsin while attending the University of Wisconsin
Platteville.
If Married, Spouse’s:
First Name ______________________ Last Name__________________________
Address_______________________________________________
City__________________________________________________
State_____ ZIP______________