Fillable Printable Payment Plan Contract
Fillable Printable Payment Plan Contract
Payment Plan Contract
Payment Plan Contract
Chapter: Date:
Host Institution:
Member Name:
Address:
City/State/Zip:
E-mail:
Check one: alumnus undergraduate
I, the undersigned member, agree to make payments on the specified dates and the agreed amounts
state on the payment schedule below to the chapter. I understand the consequences that will be brought
against me if the contact if violated. The penalties could include: account being turned over to collection
agency, expulsion from the Fraternity, and/or prosecution in a small claims court. Upon default, I agree to
pay any fees and costs that the chapter may incur in collecting my balance owed as well as a competitive
interest rate on the amount owed.
Total amount owed (beginning balance) .......................................................................... $
Payment Date Payment Amount Balance
___ / ___ / ___
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I agree that the above schedule of payments is an acceptable resolution to help retire my debt with the
chapter, and I remain current with this payment plan.
Member Date Chapter Treasurer Date
Revised 08/06
