11/21/16

University of California Davis

TEMPORARY PAYMENT AGREEMENT

COMPLETE AND RETURN TO:
University of California Davis
Student Accounting/Dutton Hall
One Shields Avenue
Davis, CA 95616-8709

Borrowers Name: ANTHONY M GAROFALO

Phone Number ___________________
Email Address ___________________

I acknowledge that I owe The Regents of the University of California the following amount(s) for student loan(s):
Loan ID

Original Amount

Payoff

Federal Perkins Loan (70300-J7868B179-01)

$11,574.00

$17,038.01

I AGREE TO:
Make monthly payments of at least $250.00 starting 12/01/16 through 02/01/18 at that time, I will either bring my
loans current or Ill call Student Accounting to arrange for a new payment plan. I will remit my future monthly
payments directly to ACS, Inc in time for the due dates of the 1th of each month - even if I dont receive a
monthly payment notice.

1.

Promptly notify Student Accounting if:

I change my name or address, or
I cannot make my full monthly payment for any reason.
I UNDERSTAND THAT:
This is a temporary arrangement and neither replaces my original repayment plan or extends the length of my
repayment period.
If I make my payments as agreed above, my account(s) will not be referred to a collection agency and will not be
subject to litigation during the temporary repayment period. However, I understand that I will be subject to all other
routine University collection procedures for past due accounts, such as withholding University services and
offsetting any California State Tax refund due to me. The status of my account will be reported monthly to
national credit bureaus.
If I fail to make my payments as agreed above, my account(s) will be considered to be in default, and may be
subject to further collection action or litigation during the temporary repayment period. The entire amount owed
may also become immediately due and payable at the Universitys option.
If my account(s) is not in current status upon expiration of this temporary agreement, I must either pay all the
remaining past due amount and resume my normal payment schedule or contact Student Accounting immediately
to negotiate another repayment schedule. Failure to do so will be considered a default and I may be subject to
further collection action and/or litigation.
Payments are due on the 1th of each month. Late fees may continue to accrue. I may make larger and/or more
frequent payments than the minimum amount agreed above.
Upon receipt of a copy of this signed agreement & Financial Statement by Student Accounting, the temporary
payment agreement will become effective and I will be sent a copy for my records.
All payments should be made payable to UC REGENTS and sent to ACS, Inc (the billing service). Payments are
due on or before the 1th of each month even if I dont receive a billing notice

a.
b.
1.
2.

3.
4.

5.
6.
7.

Mail to :

ACS, Inc
Campus Products and Services
PO Box 7061
Utica, NY 13504-7061
http://www.acs-education.com

BORROWERS SIGNATURE________________________________________DATE____________________
APPROVED___________________________________ DATE _________________________
University of California Davis
Student Accounting/ 2100 Dutton Hall
1 Shields Ave
Davis, CA 95616-8709
Phone: 530-752-3646
FAX: 530-752-5718
EMAIL: collections@ucdavis.edu