Debit Card Deposit Form printable pdf download

Debit Card Deposit Form

Student Name: _______________________________

_____________________

_______

Last

First

Program: ___________________________________

Start Date: 9-10-01

Amount of Deposit: $__________________________

Date of Deposit: ________________

Payment Type: _____ Check (#

)

____ Money Order _____ Credit Card

_____ Other

Credit Card Type: _____ Amex

_____ Visa

_____Master Card

_____ Discover

Credit Card Number: _______________________________________ Expiration Date:_______________

Name as it appears on the Credit Card:______________________________________________________

Signature:__________________________________________________ Date: ______________________

_____ Plus Loan Applicants:

I have applied for funds under the Sallie Mae

alternative loan program and authorize The Restaurant School to utilize

$_________________ of this money to be applied towards my Debit Card

__________________________________________________

_________________________

Parent/Guardian Signature

Date

_____ Sallie Mae Applicants:

I have applied for funds under the Sallie Mae

alternative loan program and authorize The Restaurant School to utilize

$_________________ of this money to be applied towards a Debit card

__________________________________________________

_________________________

Loan Applicant Signature

Date

For Office Use Only

Loan Type: _______________________________________

Amount Applied For: $____________ FA Representative:_______ Date Loan Approved:________

Debit Card Deposit Form