Offer a Settlement

Make a Monthly Payment Offer

Or Click Here to Make a Settlement Offer

In order to assure that your payment plan proposal is properly received and accurately applied to your account you must fully complete the top portion of this form. Your email address and phone numbers are critical to follow up should we need additional information from you.

This firm is a debt collector. This is an attempt to collect a debt and all information obtained will be used for that purpose.

Please call our office at (801) 748-4747 or toll free at (877) 318-4747 for more information.

Please provide the following information:

First Name:
Last Name:
Home Phone:
Work Phone:
Email:
Address:
City:
State:
Zip Code:
Reference Number:
Current Creditor Name:

Payment Plan Proposal Form

(Lump Sum Offer form below)

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 monthly payment $ (enter dollars and cents):
Date payments will commence (Use mm/dd/yy format):
Frequency of Payments
Additional information or comments:
Enter Comments Here

Authorization: I understand that this offer of settlement or proposal for a payment plan is not effective until Constantino 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 Constantino Law Office, P.C. by their due date, or Constantino Law Office, P.C., at its option, can declare the settlement offer or payment proposal withdrawn.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. Constantino Law Office, P.C. may contact me by e-mail or phone regarding this matter.

Yes, I do understand and agree to all of the terms above.

You may contact me by email or phone regarding this matter.