BYU Independent Study Application for Credit Form Header Image

Application for Credit Form

Instructions:

  • Complete and review sections 1-5.

If you have questions, please e-mail ispo@byu.edu or call (866) 741-9144.

*Indicates a required field

1. Customer Information

eg: 12-1234567

Organization Type
Legal Entity Type
501(c)(3)

Are you exempt from paying sales tax in your state?
If yes, please provide your exemption certificate in one of the following formats:

Address*

2. Billing Information

Prefer to receive invoices and statements

Billing Address (If different than customer address):

Address

3. Contact Information

Accounting Contact Info:

Accounting Contact Name*
Preferred contact method

Educational Contact Info:

Educational Contact Name*
Preferred contact method
Copy on all invoices and statements?

4. Account Setup Options

Please specify the types of charges that will be allowed on this account.*

Handling of Withdrawals and Other Credits on Your Account

BYU Independent Study invoices at least once a month. Any request for withdrawal from a course or other credit will appear in a subsequent statement. If at any time, the organizations account results in a credit balance, a check may be issued for the credit balance. All associated fees will be withheld at the time the check is processed.

You can contact the BYU Store to apply for an account for purchase course-related materials. Please contact them at 1-888-454-6884 to get your account set up. Note: Payments for course-related materials should be sent separately to the following address: BYU Store, IS Department, Provo, UT 84602

5. Authorization of Application and Credit Review

By signing my name in the box below, I am certifying that the information provided is true and accurate to the best of my knowledge. I am also certifying that I am an authorized agent allowed to execute this application with BYU Independent Study and that my organization accepts the terms as stated in this application. Additionally, I am authorizing BYU Independent Study to perform a credit review of my organization. Policies and procedures related to the use of purchase orders and the extension of credit can be found at http://ispo.byu.edu. All policies and procedures stated there are hereby incorporated by reference. Payment terms are net 30. By completing this form, I also agree to the terms and conditions found at ce.byu.edu/financial/termsAndConditions.php

I agree that if all charges I incur are not paid by the due date and if, for the purposes of collecting the amount due, BYU should retain an attorney or collection agency, I will pay all costs of collection including reasonable interest, reasonable attorney's fees, and reasonable collection agency fees, which may be based on a percentage at a maximum of 40% of the debt.

I also agree to allow BYU or its agent to contact me by email or cell phone in an effort to collect the debt. I also authorize BYU or its agent to use automated telephone dialing equipment, and to use artificial or pre-recorded voice messages in their efforts to contact me. Further I understand that I may withdraw my consent for BYU or its agent to use automated telephone dialing equipment or artificial or pre-recorded voice messages to contact me by submitting my request to the BYU Collections Office via YMessage or in writing or verbally at A-153 ASB, Provo, UT 84602; (801) 422-6634 or verbally or in writing to the applicable agent contacting me on behalf of BYU. Finally, I understand that my delinquent account may be reported to one or more of the national credit reporting agencies.


Student Support Agreement:

Our school agrees to have an individual, e.g., administrator, academic advisor, counselor or teacher support each student in their Independent Study course as a single point of contact that will monitor student progress, proactively offer assistance, and advocate for success in their course.

Do you agree to the terms of the Student Support Agreement?*
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Today's Date*
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After you submit, you'll receive a confirmation email containing a copy of this form.