|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
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
|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
|I Agree To The Above:||*|
|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.
|To prevent automated SPAM, please enter QXHW to submit your form (case sensitive):||*|
* indicates required field