Owner Request for PAYBACK PLAN | Law offices of Anderson, Givens & Fredericks P.A.

If you are represented by an attorney, you cannot submit this form. Your attorney should submit this form on your behalf or contact our managing collection attorney, D.J. Fredericks, Esquire. Click here to email D.J.

Each request for a Payback Plan requires confirmation of the information you provide by our staff for accuracy and to ensure that the most up to date and proper information is being reviewed. A substantial amount of work is necessary to ensure the information is correct and up to date. Accordingly, if your proposed Payback Plan is approved by the Association, Anderson, Givens & Fredericks, P.A. will charge a fee of $225.00 for the services provided in reviewing and preparing the Payback Plan.

Once your information and proposed Payback Plan is reviewed by the Association, you will receive notification at the email address provided as to whether your requested Payback Plan is approved or denied. If your requested Payback Plan is approved you will receive a Payback Plan Agreement to be signed and returned to our office.

FORM – INFORMATION TO BE FILL OUT:

Full Owner Name:*

First

Last
Full Association Name:*
Property Address (for payoff):*

Street Address

City

State / Province / Region

ZIP / Postal Code
Contact Address for Owner – if different than Property Address:

Street Address

City

State / Province / Region

ZIP / Postal Code
Email:*
Phone:*
Payback Plan Terms:*
Down Payment:*

(Initial payment to be applied to balance owed)
Monthly Payments:*

(Monthly payments to be paid until remaining balance owed is paid in full)
Comments:
Acknowledgment: I understand by marking this box and requesting a Payback Plan and that $225.00 in attorney’s fees will be incurred for work to review and/or prepare the Payback Plan and added to my account.*
- I understand
Acknowledgment: I understand that this is ONLY A REQUEST for a Payback Plan and the Association may not accept my proposed payment amounts.*
- I understand
Acknowledgment: I understand that requesting a Payback Plan DOES NOT mean the Association will accept the offer and automatically cease collection efforts. Collection efforts will be on hold once the Payback Plan is approved, if at all.*
- I understand
Acknowledgment: I am not represented by an attorney.*
- I confirm
Acknowledgment: – I have read, fully agree to, and understand the above terms as they are stated.*
- I confirm
E-SIGNATURE*

(Please type in your full name as it appears on your driver’s license as proof of your identity and authorization of this form.)