Payment Plan

Type of Request:

Hold (No Longer Than 30 Days)4 Month Payment Plan6 Month Payment Plan

Your Information:

Association:
Name (required):
Email (required):
Phone Number:
Street Address:
City:
State:
Zip/Postal:

Reason for requesting a payment plan/extension (REQUIRED):
(Information in this section will help determine the status of your application, approved or disapproved)

By submitting this application I agree to pay the balance (amount owed) on my account and also agree to keep current on my payment plan. I understand that payments are due on the first (1) of each month and late on the fifteenth (15). My account will be charged a late fee and a collection fee (of up to a $25) each month until I am paid in full. I understand the Association will pursue legal action to collect the debt if I default on this payment plan. I acknowledge and understand this is an attempt to collect a debt, and any information obtained will be used for that purpose.

This form will be reviewed and a letter will be mailed back to you indicating whether or not you are approved. If you are approved the letter will state the amount due each month and a paid-in-full date.

I Acknowledge that I understand and agree to the above terms. (required)