Payment Plan Request Form
IF YOU ARE REPRESENTED BY AN ATTORNEY, YOU CANNOT
SUBMIT THIS FORM, BUT INSTEAD MUST HAVE YOUR
ATTORNEY CONTACT OUR OFFICE.
You May Use This Form To Request A Payment Plan, but
IT IS ONLY A REQUEST. You Will Be Notified Whether It Is
Accepted Or Denied. If It Is Accepted You Will Receive A
Promissory Note To Sign And Return. If You Make A Payment
Prior To Acceptance, It Will Simply Be Considered A Partial
Payment On Your Balance.
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.


LOT OR UNIT INFORMATION
Subdivision Name:*
Property Street Address:*
City:*
State:*
Zip Code:*
YOUR CONTACT INFORMATION
Full Name:*
Street Address:*
City:*
State:*
Zip Code:*
Email Address:*
Cell Phone:
Home Phone:
PAYMENT PLAN REQUEST
If Prior To Lien: Request Must Be For At Least 50 Percent
Down And For No More Than 3 Monthly Payments.
Down Payment:*
Payments:*
Any Comments:
By Submitting This Request I Understand That $50 In Atty Fees
Will Be Added To My Account For Drafting The Promissory Note,
And Another $50 Will Be Added For Processing The
Installments And For Every Six Months More Of Installments Or
Any Fraction Thereof. In Addition, Interest Will Be Added
At The Allowed Annual Rate.
I Further Understand That Requesting A Payment Plan
Will Not Result In The Cessation Of Collection Efforts.
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