Your
file number with our office:
Name of the creditor you are paying:
Lump
sum settlement offer: (Payment proposal form is below)
This is an amount that you would like to offer our client as payment
in full on your account. This offer is not yet accepted by our
client. Please do not make payment until we advise that it has
been accepted. If accepted, the amount will need to be paid in
full to our office in one installment. We will advise you of the
deadline for payment. If payment is not received in our office
by that time, the full balance will become due, less any partial payment
applied.
Amount
you are offering as a lump sum settlement: $
Enter dollars and cents please.
Date
by which you are proposing to pay the settlement in full:
Please use mm/dd/yy format
Additional
Information or Comments:
Payment
plan proposal: (Settlement Offer form is above)
This
is a proposal for payments over time at an agreed amount per payment.
Your proposal is not binding on our client or our office unless it has
been accepted, and you keep the proposal by making all payments in a
timely fashion. We will advise you if your payment plan proposal
has been accepted, and when your payments are due.
Amount
you are offering as a payment: $
Enter dollars and cents please.
Date
payments will commence:
Please use mm/dd/yy format)
Frequency
of payments:
Additional
Information or Comments:
Authorization:
I understand that this offer of settlement or proposal for a payment plan is not effective until Litow Law Office, P.C.
communicates acceptance of my offer or proposal. In addition, I understand that if my offer or proposal is accepted,
that all payments must be made in the agreed amount, and must be received by Litow Law Office, P.C. by their due date,
or Litow Law Office, P.C., at its option, can declare the settlement offer or payment proposal withdrawn. In that event,
the full remaining balance will be due, and any payment made on the account thereafter will be applied against the full balance.
Litow Law Office, P.C. may contact me by e-mail regarding this matter.
Please
select appropriate choice:
Yes, I do understand and agree to all of the terms above.
You may contact me by email regarding this matter.
No, I don't agree to the terms above.
Confirmation:
After submitting this form, please wait for a confirmation page that you
can print out to keep for your records.
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