Settlement Offer Form
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.
Authorization: I understand that this offer of settlement or proposal for a payment plan is not effective until Hood and Stacy, P.A., 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 Hood and Stacy, P.A., by their due date, or Hood and Stacy, P.A., at its option, can declare the settlement offer or payment proposal withdrawn.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.
By submitting the form below I agree to the following:
Upon submission of this form a response to your request/offer will be sent in 3-5 business days.
This is a communication from a debt collector. This is an attempt to collect a debt. Any information obtained will be used for that purpose.