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I, , am financially responsible for all charges incurred while I am in attendance at Kentucky Wesleyan College. I understand that all charges for any term must be satisfied before the beginning of the next term. I further understand the finance charges will accrue on all unpaid charges and will be computed by a 'percent rate' of one percent (1%) per month, which is an ANNUAL PERCENTAGE RATE of twelve percent (12%) applied to the prior balance after deducting current payments and/or credits to the account. I agree to pay all costs related to collection of unpaid balances, including legal fees, collection fees and interest. I further allow the below-signed individual complete, unabridged access to my financial records. I understand that I may revoke the financial records access by making written request to the Cashier's Office.

    I understand that my esignature constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.

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Document name: Statement of Financial Responsibility

Unique Document ID: 7bc2f6109d8df14110dfd7709c3546fbcafa0cd7

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Timestamp	Audit
April 20, 2018 11:09 am CDT	Statement of Financial Responsibility Uploaded by KWC eForms Administrator - bblount@kwc.edu IP 24.106.144.66
April 20, 2018 11:52 am CDT	KWC Cashier - cashier@kwc.edu added by C Bryan Blount - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66
April 20, 2018 1:30 pm CDT	KWC Cashier - cashier@kwc.edu added by C Bryan Blount - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66
May 3, 2018 9:41 am CDT	KWC Cashier - cashier@kwc.edu added by C Bryan Blount - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66
May 3, 2018 9:47 am CDT	KWC Cashier - cashier@kwc.edu added by C Bryan Blount - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66
November 15, 2019 1:15 pm CDT	KWC Cashier - cashier@kwc.edu added by KWC eForms Administrator - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66
November 15, 2019 1:15 pm CDT	Kim Johnson - kimberly.johnson@kwc.edu added by KWC eForms Administrator - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66
November 15, 2019 1:15 pm CDT	Bryan Blount - bblount@kwc.edu added by KWC eForms Administrator - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66
November 15, 2019 1:22 pm CDT	KWC Cashier - cashier@kwc.edu added by KWC eForms Administrator - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66
November 15, 2019 1:22 pm CDT	Kim Johnson - kimberly.johnson@kwc.edu added by KWC eForms Administrator - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66
November 15, 2019 1:22 pm CDT	Bryan Blount - bblount@kwc.edu added by KWC eForms Administrator - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66
November 15, 2019 1:28 pm CDT	KWC Cashier - cashier@kwc.edu added by KWC eForms Administrator - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66
November 15, 2019 1:28 pm CDT	Kim Johnson - kimberly.johnson@kwc.edu added by KWC eForms Administrator - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66
November 15, 2019 1:28 pm CDT	Bryan Blount - bblount@kwc.edu added by KWC eForms Administrator - bblount@kwc.edu as a CC'd Recipient Ip: 24.106.144.66

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Audit Trail Serial# 10849f021df37837bf47265ebecc9948