Deposit Form For Non-Refundable Tuition Deposit printable pdf download

Deposit Form

A non‐refundable tuition deposit of $350 is required before enrolling to hold your space in the class. Please

complete the information below then sign and return this form along with your non‐refundable deposit to Brenau

University Office of Admissions. Your deposit cannot be processed without this form.

Mail: 500 Washington Street SE, Gainesville, GA 3050 | Fax: 770.538.4701| Scan & Email:admissions@brenau.edu

Please complete the information below. Your required tuition deposit is S350.

Name: _ _______________________________________________________________________________________

Home Address: _ ________________________________________________________________________________

City, State, Zip: ________________________________________________________________________________

Home Phone: __________________________________ Cell Phone: _ ____________________________________

Email Address: ________________________________________________________________________________

I am submitting my $350 non‐refundable deposit for (circle one): Fall Spring Summer of 20_____

I am paying by check. (Please put the student’s name in the memo section of the check.)

Name on check ________________________________________________ Check #: _________________

I am paying by credit card. (circle one)

Visa

MasterCard

Discover

Student Name: _ _________________________________________________________________________

Cardholder Name: _______________________________________________________________________

Card Number: __________________________________________________________________________

Expiration Date: _ _____________________________________ Billing Zip Code: _____________________

Signature of Cardholder: __________________________________________________________________

My signature below indicates that all information on this form is factual, honestly presented. I understand that

failure to provide accurate and true information may invalidate my admission to the University. I understand that

it is my responsibility to report any changes in this information in writing to the Office of Admissions immediately.

I further understand that my deposit is non‐refundable.

Student Signature: _______________________________________________ Date: _________________________

Deposit Form For Non-Refundable Tuition Deposit