Pay by credit/debit card every month.
Participate by completing the authorization form below.
I _____________________________authorize the Student Loan Collection Office at South
Dakota State University to automatically, on the first working day of the month, to charge my credit/debit card with such amounts that become due.
Type of Credit/Debit Card (circle one): Visa MasterCard Discover American Express
Credit/Debit Card Number: _______________________________________
Expiration Date: _______________________________________
(When expiration date expires notify us in writing of new date)
Amount Charged: $_____________ Frequency (circle one) Monthly Quarterly
Name and Address __________________________________ at which you receive __________________________________ your credit/debit card __________________________________ billings: __________________________________
Start date: _________________________
End date: _________________________
I have the right to stop the charge to my credit/debit card for my student loan payments by sending a written request to Loan Collections, Rm. 140, Administration Bldg., South Dakota
State University, thirty (30) days before the date my account is to be charged.
Student Loan No(s): ____________________________________________________
____________________________________________________
If you have more then one loan number list amount you want
applied to each loan No(s).
Social Security No: ____________________________________________________
Name (Printed): ____________________________________________________
Home Telephone: _____________________ Work Telephone: ________________
Cell Phone:____________________________________________________________
Signature: ____________________________________________Date: ____________
RETURN TO:
STUDENT LOAN COLLECTIONS
P.O. BOX 2201, ADMIN. 140
SOUTH DAKOTA STATE UNIVERSITY
BROOKINGS, SD 57007-1829