|
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.
|
PROPERTY INFORMATION
|
| Association Name: | * |
| Street Address: | * |
| City: | * |
CONTACT INFORMATION
|
| Full Name: | * |
| Street Address: | * |
| City: | * |
| County: | * |
| State: | * |
| Zip Code: | * |
| Email Address: | * |
| Cell Phone: | |
| Home Phone: | |
PAYMENT PLAN
|
If Your Total Balance Due Including Attorney Fees Is
Less Than $1,200.00, Payments May Not Be
Extended Beyond 12 Months
|
| Down Payment: | * |
| Payments: | * |
| Any Comments: | |
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 & Goldin, PC
|
| I Agree To The Above: | * |
By Submitting This Request I Understand That $100 In
Atty Fees Will Be Added To My Account For Drafting The
Consent Order And Administering The Payment Plan.
I Also Understand That Requesting This Payment Plan
Will Not Result In The Cessation Of Collection Efforts.
|
* indicates required field
|
