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.

Consent Order Request

Consent Order Request

YOUR INFORMATION

First
Last

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.