Payment Arrangement Request Form

Payment Arrangement Request Form
Name:*

First NameLast Name
Email:*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Student ID:*
Please enter in the format 'NV....'
Course Title:*
Reason for request:*
Kindly note that failure to provide supporting documents may result in the rejection of your request.
You will need to provide supporting documents to support your case. See table below: *

Cancelof
Payment Plan and Extension Terms

As we establish your payment plan or consider your extension request, please note the following:

1. Requests After Due Date
- May be extended for a maximum of four weeks.
- A surcharge of $50 per week applies (totaling up to $200).
2. Requests Before Due Date
- May be extended for a maximum of two weeks without surcharge.
- If extended up to four weeks, a $50 surcharge will apply for the final two weeks.
3. Non-Compliance
- Failure to adhere to an approved payment plan or extension will result in a surcharge of $100 per week until payments are up to date. In addition, the arrangement will be cancelled, and you will no longer be eligible to request a new plan.
I understand that requesting a payment plan is a serious matter and should only be done if absolutely necessary.I will adhere to the agreed-upon payment schedule.Any missed payments may result in consequences such as an additional late fee surcharge of $100 per week, or even termination of my enrolment.Providing false information or misusing this form may lead to disciplinary action.
Signature:*

Clear
Date of Request:*

DayMonthYear
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RTO CODE: 45082 | CRICOS PROVIDER CODE: 03966K

Sydney Campus: Suite 3.09-3.11, Level 3, 22-36 Mountain Street, Ultimo NSW 2007, Australia | Gosford Campus: Suite 5, Level 1, 153 Mann Street, Gosford, NSW 2250, Australia

www.novus.edu.au | (02) 8386 5312 | accounts@novus.edu.au
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