Home / Consent Order Request Form

IF YOU ARE REPRESENTED BY AN ATTORNEY YOU CANNOT SUBMIT THIS FORM, BUT INSTEAD MUST HAVE YOUR ATTORNEY CONTACT OUR OFFICE.

This Form Is To Request A Payment Plan ONLY IF SUIT HAS ALREADY BEEN FILED AGAINST YOU.

It Is Only A Request, And You Will Be Notified Whether It Is Ultimately Accepted Or Denied. If It Is Accepted You Will Receive A Consent Order To Sign And Return. If You Make A Payment Prior To Acceptance, It Will Simply Be Considered A Partial Payment On Your Total Balance Due.

This Law Firm Is Deemed A ‘Debt Collector’ Under The Fair Debt Collection Practices Act. We Are Attempting To Collect A Debt, And Any Information Obtained Will Be Used For That Purpose.

YOUR INFORMATION

PROPERTY INFORMATION

PAYMENT PLAN REQUEST

If Your Total Balance Due Including Attorney Fees Is Less Than $1,200.00, Payments May Not Be Extended Beyond 12 Months

By Checking The Box Below, I Certify That I Am Not Represented By An Attorney, But I Am Instead Representing Myself And Give Explicit Permission To Be Contacted Directly By Rome & Associates, PC

By Submitting This Request I Understand That $50 In Atty Fees Will Be Added To My Account For Drafting The Consent Order And Another $50 For Processing The First Six Installments, and $50 For Each Additional Six Months Or Fraction Thereof. In Addition, Interest Will Be Added At The Allowed Annual Rate. I Further Understand That Simply Requesting A Payment Plan Will Not Result In The Cessation Of Collection Efforts.


This Law Firm Is Deemed A ‘Debt Collector’ Under The Fair Debt Collection Practices Act. We Are Attempting To Collect A Debt, And Any Information Obtained Will Be Used For That Purpose.