SAINT MICHAEL SCHOOL

21 Sixth Street, Lowell, MA 01850

TUITION PAYMENT PREFERENCE FORM

2010 – 2011

STUDENT LAST NAME:

STUDENTS:

1. Grade Tuition $

2. Grade Tuition $

3. Grade Tuition $

4. Grade Tuition $

FAMILY TOTAL $

This form must be returned to the school by May 3, 2010.

PLEASE COMPLETE THE FOLLOWING:

PARENT/GUARDIAN FULL NAME:

ADDRESS:

CITY/TOWN, STATE, ZIP:

PHONE (Home): (Work)

OPTION 1 – Single payment made directly to the school due July 1, 2010.

($75 discount per student will apply only if payment is received by July 1, 2010)

OPTION 2 – Semester payments due July 1, 2010 and December 1, 2010

made directly to the school.

OPTION 3 – Ten monthly payments beginning in July, 2010 automatically

withdrawn from your account through FACTS Management Company.

PLEASE NOTE: If you choose Options 1 or 2 and payment is not received on the due date, you will be required to go on FACTS.

For questions/information, please contact the school office at (978) 453-9511.

Parent/Guardian Signature Date