For Business Office use only
Date received:
Approved by:
MCRG/Invoice number:
Check number:
Date mailed/picked up:
(circle)
PACIFIC UNIVERSITY
PENDLETON/SHORT TERM LOAN APPLICATION AND PROMISSORY NOTE
Incomplete applications will not be processed.
Name (print last, first, middle initial)
Social Security number
Home (mailing) address
Student ID number
Phone number
(home)
(work)
Amount of loan $
How will this loan be repaid?
A $25 non-refundable fee will be deducted from amount of loan upon disbursement.
I may be responsible for a stop-payment fee.
(initial here)
(initial here)
I agree and understand in the event the amount of the short term loan is not deducted from my financial aid
disbursement, I am obligated to pay the University the balance of the short term loan in full upon receiving my
financial aid refund.
(initial here)
INDICATE HOW WOULD YOU LIKE TO RECEIVE YOUR CHECK:

BY MAIL
PROVIDE COMPLETE MAILING ADDRESS:
OR
HOLD FOR PICK UP AT THE BUSINESS OFFICE (photo ID required at the time of pick up)
For value received, the undersigned maker(s) jointly and severally promise to pay to the order of Pacific University on or before the _____ day
of __________, or if earlier, the last day of enrollment, the sum of $
. The unpaid balance may be paid at any time prior to the due
date without penalty. Any refund due the borrower due to early withdrawal will be applied against payment of this loan.
The undersigned further agrees that in the event the maker(s) fail to repay the full amount due to the University on or before the due date of
this loan, interest will accrue at the rate of five percent per annum, and the unpaid balance is subsequently collected by an attorney or a
collection agency, the maker(s) will pay all attorney’s fees and other costs and charges incurred in connection with the collection of the paid
balance of this loan.
Academic transcripts and/or diplomas will not be released for students delinquent on their loans at the time they are requesting the transcript
or leaving the University. Students terminating their enrollment at the University will have their loan due date changed to reflect their last day
of enrollment.
Borrower’s signature
Date
Co-signer’s signature (may not be required)
Date
FOR BUSINESS OFFICE USE
Program:
Financial aid disbursement date: