Payment Arrangement Form

PLEASE READ CAREFULLY

Below is the Payment Arrangement Form. To establish a payment arrangement, you must:

• Complete and submit the form.

• Pay 15% of your total outstanding balance at the time the arrangement is established.

The 15% payment is not an additional fee. It will be applied directly to your account balance and serves as your commitment to the agreed-upon payment arrangement.

Please note: A payment arrangement will not be considered active until both the completed form and the required 15% payment have been received.