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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.
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LOT OR UNIT INFORMATION
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| Association Name: | * |
| Property Street Address: | * |
| City: | * |
| State: | * |
| Zip Code: | * |
YOUR CONTACT INFORMATION
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| Full Name: | * |
| Street Address: | * |
| City: | * |
| State: | * |
| Zip Code: | * |
| Email Address: | * |
| Cell Phone: | |
| Home Phone: | |
PAYMENT PLAN REQUEST
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If Prior To Lien: Request Must Be For At Least 50 Percent
Down And For No More Than 3 Monthly Payments.
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| Down Payment: | * |
| Payments: | * |
| Any Comments: | |
By Submitting This Request I Understand That $100 In
Atty Fees Will Be Added To My Account For Drafting The
Promissory Note And Administering The Payment Plan.
I Also Understand That Requesting A Payment Plan
Will Not Result In The Cessation Of Collection Efforts.
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* indicates required field
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