Payment Plan Authorization & Agreement

Complete the form below to authorize weekly auto-debit payments and confirm you understand the no-refund and collections policies.

Student information

Full legal name (First and last name)*

Email address*

Mobile phone*

Course & schedule

Select your course*

Payment plans are not available for Pharmacy Technician or Medical Assistant programs.

Class start date*

Weekly auto-debits begin 10 days before this date.

Upfront amount you are paying today

Includes application fee + $50 payment plan fee.

Agreed weekly payment amount

Example: CNA Day — $250/week for 4 weeks.

Invoice schedule

Below is a read-only schedule of the invoices that will be created for this payment plan. Dates and amounts are generated from your selected plan and cannot be edited.

#	Due date	Amount
No plan selected yet.

These invoice entries are read-only and will be submitted with your agreement.

Debit / credit card authorization

By entering your card information below, you authorize automatic weekly charges each Friday for your payment plan until your balance is paid in full.

Name on card*

As it appears on card

Card number*

Expiration date (MM/YY)*

CVV*

Billing address*

Agreements

I understand that all payments (including the $50 payment plan fee) are non-refundable for any reason, and that all payments must be made on time. I authorize Health Careers Training Institute to automatically charge debit/credit card every Friday for 4 weeks beginning no sooner than 10 days prior to the start date of class. I understand that if any payment is missed, declined, or late, my registration may be canceled and I may be removed from class. I understand and agree that Health Careers Training Institute reserves the right to pursue collections, including third-party collection agencies, for any unpaid balance on this debt. I have read and understand the No Refund Policy and understand that there are no refunds of any payment for any reason.

Your digital signature(s) below confirm your authorization to charge the debit/credit card on file and your agreement to our no-refund and collections policies.

Signatures

Signature — Card authorization (draw your signature)*

Authorizes us to charge your debit/credit card for scheduled weekly payments.

Signature — Collections consent (draw your signature)*

Acknowledges our right to pursue collections for any unpaid balance.

Date of agreement*

Student ID (assigned)