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Payment Plan Questionnaire

We are scheduling appointments to modify your payment agreement.  BEFORE you schedule your appointment, complete the above questionnaire and be prepared to provide all proof of income, including the last 4 consecutive weeks of pay stubs, as well as any proof of unemployment or disability.  Once you have that information available, then you can schedule your video meeting by clicking on the link below.  If you are not prepared at the time of the video, we will need to reschedule your video meeting.  All proof of income or lack of income MUST be available in order to complete the Payment Modification. You will be sworn in and required to sign the Payment Plan Questionnaire and Agreement under oath.  During our meeting, you will be required to email the signed forms back to our office.

Once you have that information available, then you can schedule your video meeting by clicking on the link below.  If you are not prepared at the time of the video, we will need to reschedule your video meeting.  All proof of income or lack of income MUST be available in order to complete the Payment Modification. 

You will be sworn in and required to sign the Payment Plan Questionnaire and Agreement under oath.  During our meeting, you will be required to email the signed forms back to our office.