College Course Payment Form 2011/2012 - The Bournemouth ...

LEARNER REFERENCE (College use only)College Course Payment Form 2011/2012IMPORTANT Payment must be made with this form.Applying for reduced fees (see section 5)1. Student Name Course Code2. Payment Details (Please tick as appropriate)Amount PayableI am paying (complete section 3)My employer is paying (complete section 4 and provide authority from your employer)I am under 19 I am applying for a reduced fee (see section 5)I am paying but will claim fees back from my employerAdvanced Apprentice3. Payment Method(Please tick as appropriate)Credit/Debit Card Cash (cash payments in person only) Direct Debit (Instalments)* (£10 fee applies)*Please note that all fees remain payable should you decide to withdraw from the courseAll Course fees under £350 must be paid in full at enrolmentFull cost courses - of 16 wks or more duration and £350 orover• Pay in full on enrolment by cash or credit/debit cardor• Payment by 4 instalments, 40% payable on enrolmentby cash or credit/debit card followed by 3 equal directdebit payments (to be paid in full by the completion ofthe course).††Direct debit mandate must be set up at the time of enrolment. All feesremain payable should you decide to withdraw from the course.Instalment option not available on all full cost courses.Other Courses - £350 or over(Excludes full cost courses, Foundation Degrees and specific courseswhere indicated)• Payment by direct debit, 20% payable on enrolment bycash or credit/debit card followed by a number of equalmonthly payments (to be paid in full by the completion ofthe course).††Direct debit mandate must be set up at the time of enrolment. All feesremain payable should you decide to withdraw from the course.4. Employer/Sponsor/Training Provider detailsUnless otherwise stated, published fees cover August 2011 - July 2012 onlyPlease note• A Purchase Order or some other authority from your employer is required, to guarantee proof of support.Until this is recieved by The College you remain liable for your college fees.• Progress/Attendance reports will be provided to your employer. To opt out of this service please tick hereSignature of learner:Company Order No.Company Name:Contact Name:Contact Telephone Number:AddressPost Code5. I wish to apply for a fee reduction (Please tick as appropriate) (current proof of benefit will be required at enrolment)All fee reductions are subject to conditions. You will be asked for proof of current income-related benefit or to sign adeclaration form.Job Seekers Allowance (JSA) (available for part-time courses only)Employment Support Allowance in Work Related Activity Group (ESA) (available for part time courses only)This is my first full Level 2 qualification and I am entitled to a reduced fee.I am aged 19 to 24 years old, this is my first full level 3 qualification and I am entitled to a reduced fee.Date:FOR COLLEGE USE ONLY Fee reduction approved

Payment by Credit/Debit CardI authorise The Bournemouth & Poole College to charge payment to my credit/debit card.Cardholders NameCard No.Expiry Date Valid From Date Issue Number (Switch only)Amount (£)Signature(s)Direct Debit MandateInstructions to your Bank orBuilding Society to pay by Direct DebitPlease fill in the whole form using a ball point pen (do not detach)Name(s) of Account Holder(s)ReferenceBank/Building Society account numberFOR OFFICIAL USE ONLYThis is not part of the instruction to your Bank or Building Society.Deposit 20% / 40% (F) =Branch Sort CodeMonthly payments ofTotal =To: The ManagerAddressBank/Building SocietyPost CodeInstruction to your Bank or Building SocietyPlease pay The Bournemouth and Poole College Direct Debits from theaccount detailed in this instruction subject to the safeguards assured bythe Direct Debit Guarantee. I understand that this instruction may remainwith The Bournemouth and Poole College and, if so, details will bepassed electronically to my Bank/Building Society.Service User Number (SUN)8 4 3 3 3 0Signature(s)DateBANKS AND BUILDING SOCIETIES MAY NOT ACCEPT DIRECT DEBIT INSTRUCTION FROM SOME TYPES OF ACCOUNTThe Direct Debit Guarantee• This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits• If there are any changes to the amount, date or frequency of your Direct Debit The Bournemouth and Poole College will notify you 10 workingdays in advance of your account being debited or as otherwise agreed. If you request The Bournemouth and Poole College to collect apayment, confirmation of the amount and date will be given to you at the time of the request.• If an error is made in the payment of your Direct Debit, by The Bournemoth and Poole College or your bank or building society you are entitledto a full and immediate refund of the amount paid from your bank or building society - If you receive a refund you are not entitled to, you mustpay back when The Bournemouth and Poole College asks you to.• You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Pleasealso notify us.FOR COLLEGE USE ONLYTuition Fee Due £Other course costs Due £Total amount Due £Invoice/Receipt NumberAmount Paid Today £Processed byDateOther Notes