In order to apply for the PACE plan, please complete the application form and return it to: Campus Billing Services - PACE UCI PACE PLAN - APPLICATION FORM Student Information - Please print clearly. I wish to apply for the UCI PACE Plan to cover Registration Fees (and Tuition, if applicable): Last Name____________ First Name____________ Middle Name____________ Billing Address ____________________________________________________ City, State, Zip _____________________________ Phone (___)_____________ Permanent Address _________________________________________________ City, State, Zip _____________________________ Phone (___)_____________ PLEASE NOTE: Monthly billing statements will be mailed to the billing address, only- Mail my PACE AGREEMENT to: [ ] Billing Address [ ] Permanent Address [ ] Other Other Address _______________________________________________________ City, State, Zip ____________________________ Student ID# ______________________ [ ] Undergraduate [ ] Graduate Birthdate ____________________ Driver's License # ____________________ Signature of Student __________________________ Date ________________ A new PACE agreement will be sent to you each quarter for which you have been assessed fees, unless you notify us otherwise. PACE participation fees, terms and conditions are subject to change without notice. |