CCLC Payment Plan Form

When possible, the CCLC requests that participants make a deposit of at least 25% of the course fee.  The Center is happy to work with all potential participants to create a payment plan that works for the participant and the Center.

________________________________  pledges to pay _____________________
(Participant name)                                                                            (amount)

every ____________  week(s) / month(s) for a period of ________________________
                                                                                                    (number of weeks/months)

until the full course fee of ________________ is paid. Course____________________

Address_____________________ Town______________ State______ Zip_________

Phone____________________ Email_______________________________________

_______________________________              ________________________________
Participant’s signature                                             CCLC Staff Member Signature                     

For office use only

Please mail or bring this form to: CCLC, 10 Commissary Point Road, Lubec, ME 04652 or fax to: 733-2262 Someone will contact you to discuss your payment plan.