This document authorizes an organization to pay tuition, fees, books, and supplies for an employee enrolled in an occupational training program at Lake Michigan College. It provides the employee and organization details, specifies the semester and year covered, and authorizes charging the organization's credit card for invoiced amounts. The organization representative's signature commits the organization to paying all billed amounts regardless of whether the employee remains employed or successfully completes the class.

1. LAKE MICHIGAN COLLEGE
OCCUPATIONAL TRAINING PROGRAM
TUITION/BOOKSTORE PAYMENT AUTHORIZATION
________________________________will pay: Tuition and Fees maximum amount: _______________
(ORGANIZATION)
Books maximum amount: _______________
Supplies maximum amount: _______________
Upon invoicing by Lake Michigan College for ____________ semester _________for the following employee:
(year)
__________________________________________ ___________________________________
(EMPLOYEE NAME) (SOCIAL SECURITY NUMBER)
(STUDENT ID)
To have your credit card charged, please complete:
__________________________________________ _____________________________________
(NAME ON CREDIT CARD) (CREDIT CARD NUMBER)
_______________ _________________ _____________________________________
(SEC. CODE) (EXP. DATE) AUTHORIZED SIGNATURE
SEND INVOICE TO:
__________________________________________ ____________________________________
(ORGANIZATION REPRESENTATIVE) (TITLE)
__________________________________________ ____________________________________
(STREET ADDRESS) (CITY STATE ZIP)
__________________________________________ _______________ ________________
(REPRESENTATIVE’S SIGNATURE) (DATE) (TELEPHONE)
NOTICE: Organization representative’s signature commits the organization to payment of the total payment
due when billed, subject to policies outlined in the Lake Michigan College catalog. This commitment remains
whether or not the employee continues employment with the organization, withdraws, or passes the class with a
satisfactory grade.
Please mail this form to: Lake Michigan College, Attn: Accounts Receivable, 2755 E. Napier Ave.,
Benton Harbor, MI 49022, or fax to (269) 927­8103. If you have questions please call (269) 927­8100 ext. 5054.