Deferred Payment Plan and Promissory Note Payment Schedule

Deferred Payment Plan and Promissory NoteI ____________________________________, Banner ID A_____________________________, promise to pay to the order of Santa FeCommunity College(SFCC) at its offices in Santa Fe, New Mexico, for monies, educational services and/or goods received, the sum of TotalCharges and Non-refundable Fee in the amounts and on the dates indicated below. I understand and agree that this extension of credit, to theextent advanced to me, constitutes a loan of funds and/or other resources of SFCC and must be repaid; and further agree that the purpose of thisextension of credit is to assist me in obtaining an education. Any unpaid principal balance may be paid at any time prior to due date(s). If I receivefinancial or scholarship aid, I understand and agree that this aid will be applied to the amounts due or to the amount of credit provided to me or onmy behalf in accordance with College policy.Amount ofNoteNote:$ Fee: Amount and Fee:$PAYMENT:SFCC may establish different payment terms in a supplementalrepayment schedule which shall be attached to and made a part of thisNote. I must pay the entire unpaid balance of this Note on or before theFALL/SPRING SEMESTERSlast Payment Date.DEFAULT:If I fail to make any payment required: before the first day of semester forthe class(es) for which I have used this deferred payment plan to hold myreservation I understand I will be assessed a thirty dollar ($30) cancellationof reservation fee before any of my initiating payment funds are refundable,or by this Note when due, or if any Holder at any time believes for any reasonthe prospect of receiving any payment is impaired, the entire unpaid balanceshall become due and payable without notice on demand, and I shall pay ondemand all costs and expenses of collection, including reasonable collectionagency and attorney fees incurred or paid by any holder in attempting toenforce payment of this Note (not to be less than 10 percent of the unpaidamount of this Note at the time of enforcement).If I fail to make any payment required by this Note when due, I shall paythe Holder of this Note a late charge equivalent to 15.39 percent per year(1.2 percent per month) unless this late charge is waived by the holderhereof in writing. Any late payments will be applied first to the accruedlate charges and then to payments which are due.Payment ScheduleScheduled amounts are due on or before payment dateTotal ChargesInitial Payment 25% + FeeTotal DeferredPayment Date Amount Due__________ _____________________ _____________________ ___________OTHER CONDITIONS:1. I am aware of my responsibility to pay all SFCC charges not includedin this Note whether incurred before or after the disenrollmentdeadline date, including courses added and dropped2. I am aware that current and additional SFCC services may be withheld ifany payment required by this Note is not made when due.3. If I withdraw from SFCC, any refunds due to me may be applied to the unpaid balance of this Note.4. If I am employed, now or in the future by SFCC, SFCC may apply my earnings to any payment not made when due under theterms of this Note.5. Jurisdiction and venue for any lawsuit brought to enforce the terms and conditions of this Note shall be proper in Santa FeCounty, State of New Mexico. This Note shall be governed by the laws of the State of New Mexico.6. I agree that any and all additional amounts which I may subsequently owe to SFCC may, at the holder’s option, become subjectto the terms and conditions of this Note, including but not limited to late charges and attorney’s fees.I hereby waive protest, demand, presentment, notice of dishonor, and notice of protest in case this Note, or any installment duehereunder, is not paid at maturity, and agree that after maturity of this obligation or any installment thereof, the time of makingpayment of the same may be extended without prejudice to the holder and without releasing any maker, endorser or surety hereof.IN SIGNING THIS PROMISSORY NOTE, I ACKNOWLEDGE RECEIPT OF A COPY, CERTIFYING THAT IT WAS COMPLETE PRIOR TO SIGNING.$___________$___________$___________$___________$___________Student Signature: _______________________________________________ Date: _________________________________FOR OFFICE USE ONLY:SFCC APPROVAL SIGNATURE: _________________________________________Date: __________________________Deferred Payment Plan[1].doc

PROMISSORY NOTE APPLICATIONBanner ID ___________________STUDENTS NAME _____________________________ SSN ________________________BIRTH DATE_____________ DRIVER’S LICENSE # ___________________STATE _____EMPLOYER___________________________ WORK PHONE _ ___________________CITY ______________________ STATE ___________________ ZIP CODE ___________SPOUSE’S NAME ______________________SPOUSE’S EMPLOYER ________________PRESENT ADDRESSPLEASE PROVIDE A CURRENT DELIVERABLE ADDRESSADDRESS _______________________________________________________________CITY ________________________________ STATE _____________ZIP CODE _______PHONE_____________________________ E-MAIL ADDRESS __________________PERMANENT ADDRESS (if different than Present Address)ADDRESS _______________________________________________________________CITY ______________________ STATE ___________________ ZIP CODE __________PHONE ( ) __________________LIST A REFERENCE IN A DIFFERENT HOUSEHOLDNAME ___________________________________________________________________CITY ______________________ STATE ___________________ ZIP CODE ___________PHONE _______________________________________Deferred Payment Plan[1].doc