Notes

Thank you for your interest in Bromley Hall. Please print this page for your records.

Your application has been received and processed. The following is a partial listing of the information you provided. You will receive written confirmation of your room and board accommodation within 14 days. Your application was received on: 05/04/2016 at 1:09 AM

UID: 652198565
First Name: Will
Last Name: Kepler
Address: 717 Brierhill Road
City: Deerfield
State: Illinois
Zip Code: 60015
Country: United States
Requested Room Type: Double Room with All Meals Served ($12,880)
Parent First Name: Debbie
Parent Last Name: Kepler
Billing Email Address: [email protected]

DEPOSIT TOTAL: $350

I hereby acknowledge that I have received, read, understand, and agree to the terms and conditions contained in the Bromley Hall Room and Board Agreement. I agree to be bound to the Room and Board Agreement terms and rates for the 2016/2017 Academic Year as indicated on the Room and Board Agreement Addendum. I hereey authorize my electronic signature as submitted herewith to be as valid and binding as my original signature.

STUDENT's electronic signature as last four (4) digits of Social Security Number ENTERED AS: 7377

FOR VALUE RECEIVED, and in consideration for, and as inducement to The Bromley Group of Companies, Inc, as the AGENT for Bromley Hall, making the foregoing Agreement, the undersigned guarantees tot eh AGENT full payment and performance by the STUDENT of his or her obligations under the Agreement without requiring notice of non-payment, non-performance, or proof of notice or demand, all of which the undersigned expressly waives, and the undersigned expressly consents to any modifications of the Agreement, including but not limited to extensions fo th term of the Agreement and adjustments to the room and board rates contained in the Agreement, and any extensions of time or indulgences granted by the AGENT to the STUDENT. I HAVE READ AND UNDERSTAND THE REFUND AND LIABLITY PROVISIONS CONTAINED IN THE AGREEMENT. I hereby authorize my electronic signature as submitted herewith to be as valid and binding as my original signature.

PARENT/GUARANTOR's electronic signature as last four (4) digits of his/herSocial Security Number ENTERED AS: 2468

Your accommodations are not guaranteed until you receive written confirmation. If you do not hear from us within 14 days, please contact our office via e-mail at [email protected] or call 217-384-6100. We are looking forward to having you as one of our residents next year.