<< Bursar's Office
Bursar's Office, Kumble Hall
C.W. Post Campus, Long Island University
720 Northern Blvd., Brookville, New York 11548
Fax:
516-299-2721
Deferred Payment Plan
Application and Agreement
Print, fill out and mail/fax to above address/fax number
   
Student Name:
(Last, Firs, Middle Initials)
     
Student ID Number:
 
Year/Term:
 
School/Divesion of LIU:
 
Permanent Home Address:
 
Phone Number:
(        )
Email Address:
 
 
 
To obtain your current tuition and fees and anticipated financial aid, click on to the Student Information System (SIS) at www.liu.edu/SIS. Please refer to the following categories (Summary of Your Billing, Financial Aid, Payments and Refunds and Financial Aid Details) to fill in the required information below.
Tuition & Fees:
$
Room & Board:
$
Total Charges:
$
Total Anticipated Financial Aid:
$
Net Amount Due:
$
(Send payment of 50% of Net balance plus $15 deferment fee, together with signed deferment application. You will receive a confirmation with amounts due and dates in the mail.)

I hereby authorize that my SFA funds be used to cover all my charges. In return for permission to continue in attendance, I promise to pay Long Island University my outstanding balance according to the schedule mailed to me. I understand and agree to the terms and conditions of the Deferred Payment Plan of the University and acknowledge that this agreement is a binding obligation even though I may be under 21 years of age. I further understand that if any of the financial aids listed above are canceled or reduced after the issuance of this clearance form, I am responsible for all indebtedness involved. I agree to pay all collection costs should the University turn this account over to an outside collection agency. I also agree to pay a $10.00 late payment fee for each delinquent payment.
Student Signature:
 
Date:
 
Payment can be made by:
  - Personal Check
  - Bank Draft or Money Order
   Made out to Long Island University 		You may also pay by Credit Card:
  - VISA
  - Mastercard
  - Discover
I authorize Long Island University to charge my account in the amount of:
$
Credit Card Type:
VISA
 
Mastercard
 
Discover
 
Credit Card Number:
 
Credit Card Expiration Date:
   
(mm/yy)   
CVV2 Security Code (3 Digits)
 
Cardholder Name:
     
Phone Number:
  (        )
Mailing Address:

Zip Code:
 
Cardholder Signature: