ACH Payment Request Form
Your Information

Student's Information



ACH Payment Plan

The fee for participating in the monthly tuition payment plan is $75.00 per year, with no monthly interest being charged on the ACH Total. This fee will be incorporated into the payment plan. A service fee of $30.00 will be imposed on any returned/refused transactions (i.e. NSF, etc.).

If the actual charges exceed the monthly payments, you must pay those additional charges to Augustana University at the beginning of each semester or as soon as they are incurred. Interest will accrue on all past-due student account balances that are in excess of the ACH total

Secure Link
After submitting this form, you will receive a separate email with a secure link to upload the completed ACH Pay Plan Electronic form.  The form can be found at