HES

APPLICATION

Apply Online

You can apply for a payment plan with HES using this on-line application. You are enrolling in a program that is specifically designed for the school you are attending and you will be required to comply with the terms and conditions of your respective school’s plan. You can review the details of your respective school’s plan by contacting HES on 1-800-422-0010 and requesting a copy of the school specific brochure or you can review the brochure on-line via the school’s website or the HES website. Please make sure that you have read and understand all of the terms and conditions of the program including the start date, program length, due dates, etc. before sending your electronic application.

To apply for the payment plan electronically, you will need to complete the following information. All fields listed in red are required fields and must be completed for your application to be accepted:

Student Info
First Name:	MI:	Last Name:
Address (permanent):
City:	State:	Zip Code:
Telephone Number: (555-555-5555)
School Name, College or University:
Student ID Number (if known):
Expected Graduation or Separation Date:
E-mail Address:

Budgetor (Parent/Guardian) Information
First Name:	MI:	Last Name:
Address (permanent):
City:	State:	Zip Code:
Telephone Number: (555-555-5555)
Birth Date: (MM/DD/YY - For insurance purposes only where applicable)
E-mail Address:

Budget Amount/Payment Information
Amount Needed to Budget:
Number of Payments:
Use the HES Worksheet to assist you in calculating your Budget Amount

HES Worksheet (Optional)

1. Expenses
Tuition	$
Fees	$
Room and Board (If Applicable)	$
-------------------------------------------------------------
TOTAL EXPENSES	$

2. Credits
Deposit (Paid Directly to School)	$
Scholarships or Grants	$
Loans	$
-------------------------------------------------------------
TOTAL CREDITS	$

HES offers participants a number of different methods for making monthly payments. Please select the method that you would like:

Payment Coupon Book

HES will mail you a payment coupon book for your monthly payments. The initial payment coupon will include the monthly payment amount and the application fee for enrollment in the plan. First payments are due even if you have not yet received your payment coupon book. Please mail in your payment with your name in the memo field of the check OR print out a copy of this application and mail it together with your check.

I would like to have HES automatically deduct my monthly
payments directly from my checking or savings account
EACH MONTH

HES will automatically charge your account EACH MONTH for your monthly payment amount on the payment due date. The initial deduction will include the application fee for enrollment in the plan and the initial payment due at the time of enrollment. If you are electing this option you will need to complete the following information:
Bank Name:
Bank Routing Number:
Account Number:
Account Type (checking or savings):

I would like to have my FIRST PAYMENT ONLY deducted from my checking or savings account immediately. (Note: this option is only authorizing HES to debit your account for the first payment. . You will be responsible for mailing the remaining payments or making these payments online. The first payment is the amount that is due to bring your account up-to-date based on the time of your enrollment.)

Bank Name:
Bank Routing Number:
Account Number:
Account Type (checking or savings):

I would like to make my FIRST PAYMENT ONLY by credit card
     through the HES website. There is a convenience fee for using
     this service. I realize that, once I submit this application, I will
     need to go to the HES website and make the credit card
     payment.

Once you have submitted your application, you will need to go to the credit card payment page of the HES website, www.highereducationservices.org to make your payment. Click on the HES on-line payment icon on the right hand side and click on the words "click here" at the end of the first paragraph. You will need to complete the requested information and submit the information in order for your credit card to be processed. There is a convenience fee for using this service.

Comments

Before sending your application, you must read the following statement.

I, the above participant hereby apply for enrollment in the Installment Payment Plan administered by Higher Education Services, Inc. (HES). I understand that, as an enrollee in IPP, I will be entitled to the benefits provided by the IPP/HES Plan. I will be required to comply with the terms and conditions of the IPP/HES Plan as outlined in the brochure for the plan that I am enrolling in, including the payment of the application fee and the monthly installment payments of the total budgeted amounts of tuition and fee charges. I understand and intend that this on-line Application will constitute a legally binding agreement.

You acknowledge that you read and understood this statement and you enter into this Agreement by entering your last name, your telephone number and your zip code and submitting this application:

Last Name:
Phone Number:
Zip Code:

Print a Copy of your Application

Students & Families

Schools

Questions?
Call us : 1-800-422-0010
Email us:

HES
4720 Carlisle Pike
Suite 200
Mechanicsburg, PA 17050

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