Jenzabar University

Student Name:

Student ID#

Program:

To enroll in the payment plan, answer "yes" to the question below. You will then be directed to fill out the payment plan application.  Once the business office has processed your application, it will be completed on your My Checklist page.

Once you complete your application and it has been processed (1-3 business days), you will see it reflected on your online bill with a payment plan fee and updated due dates.

Select the term and year you are applying for:

Term:

Once you have signed up for one term, your payment plan will automatically roll forward to new semesters unless you request to be taken off of the plan.

Would you like to be on the monthly payment plan?

Northwestern College Electronic Transfer Form (EFT)
AUTHORIZATION AGREEMENT FOR DIRECT PAYMENT

I (we) hereby authorize Northwestern College of Orange City, Iowa, to make the following transfer of funds from my bank account for payment of NWC student bill.

Frequency: Monthly on the twenty-fifth of each month of the payment plan

Name of Domestic Financial Institution:

Address of Domestic Financial Institution:

^If you are unsure of your bank account information, please call your financial institution.

Domestic Financial Institution Routing Number^:

Type of Domestic Bank Account:

Domestic Financial Institution Account Number^:

Name(s) on Domestic Bank Account:

Address:

City:

State:

Zip:

Phone Number of Account Holder:

E-mail Address of Account Holder:

By signing this form, I (we) authorize Northwestern College to initiate withdrawals for my (our) monthly student bill payment and, if necessary, adjustments for any entries in error to my account on the 25th day of each month of the payment plan. If the 25th falls on a Saturday or a Sunday, the transaction will occur the Monday after. This authority will remain in effect until I/We notify the Bank and Northwestern College in writing to cancel it. The notice must be received at least 5 business days before the scheduled transfer in order to stop payment. All bank account changes must also be received at least 5 business days before the scheduled transfer. I am responsible for any NSF (nonsufficient funds) fees that Northwestern College incurs due to my bank account not having enough money to cover the monthly student bill payment on the 25th day of each month.

If a payment is not made on the date it is due because of nonsufficient funds, the entire balance becomes due and interest of 1 percent per month (12 percent per year) will be charged to the student’s account.

Signature(s):