Rome Test Page 2

LOT OR UNIT INFORMATION

PAYMENT PLAN REQUEST

If Prior To Lien: Request Must Be For At Least 50 Percent Down And For No More Than 3 Monthly Payments.

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 $150 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.