Payment Arrangements
This area is used to propose payment arrangements to us. You can also use this area to request an adjustment to your current payment arrangements. Please be sure to fill out all required fields as well as any optional fields as appropriate. Please allow one business day for a response to your proposed arrangements. All payment arrangements are subject to approval. Failure to adhere to payment arrangements may limit your opportunity to propose your own arrangements in the future unless you communicate with us and make new payment arrangements prior to missing a promised payment. Your submission will be sent securely.
* Required
Email address *
Your email
Are you proposing new payment arrangements or requesting an adjustment to current payment arrangements? *
Full name exactly as it appears on your notice from us *
Your answer
If your name is misspelled or has legally changed, please type it below.
Verification may be required prior to applying a name change.
Your answer
For verification, please enter only the last 4 digits of your Social Security Number. *
Your answer
For verification, please enter your date of birth. *
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If you would like to change the address on file, please enter it below.
Your answer
What is the best phone number to reach you at? *
Please enter only numbers without spaces, dashes, etc., example 2195551212
Your answer
What is your 10 digit Diversified Consumer Services account number? *
This is listed as "New Account Number" on the first letter you received. If you do not have the account number, enter "UNKNOWN" (without the quotation marks).
Your answer
When can you make your first payment on these proposed arrangements? *
How often do you propose to make payments? *
How much do you propose each payment to be? *
Please enter with or without a $ but don't forget to use a decimal where appropriate. Example: $50.00 or 50.00
Your answer
How do you propose to make your payments? *
You may change your method of payment any time. This is just to let us know your plan.
Are you currently employed? *
If your payment arrangements proposed are accepted, do you agree to make your payments on the schedule you proposed on time, every time to the best of your ability? *
You must answer "Yes" to this question.
If you cannot make a payment when due, do you agree to communicate this to us and propose a new payment arrangement either for that payment or that and all future payments? *
If there is anything about your circumstances you feel would be important for us to know, please let us know here.
Your answer
Most accounts are NOT charged a monthly fee. However, there are exceptions depending on your account type, length of payment term or other factors. If a fee will be assessed, you will be advised of this fee in the course of reviewing your payment proposal. For example, you MAY be charged a monthly account maintenance fee of $10. This fee will be reduced to $5 per month if you authorize us to communicate with you via email and through our website. In the event you are charged this fee, once you have made 6 (six) consecutive payments on time, we will waive the monthly maintenance fee as long as payments continue to be made on time. If a late payment is made, you will be charged the monthly maintenance fee for that month, but not for subsequent months under this same arrangement. Instead of that example, you may be charged a ONE-TIME fee (that would be deducted from your payments so you don't have to make an extra payment). IF a fee is charged, whether one-time, monthly, or monthly for a term, it will NOT be an unreasonable fee and UNDER THE LAW, we are limited to fees that can be assessed based on many factors. This is why, MOST accounts do not have any additional fees added. *
By authorizing us to communicate electronically, we will email correspondence to you instead of mailing it. There may be some notifications that have to be mailed. This does not affect your reduced fee, if a fee applies to your account. You can return to paper (mailed) communications at any time, subject to the higher monthly maintenance fee.
AGREEMENT: I certify that the information I am submitting to you is accurate to the best of my knowledge. I understand that my proposed payment arrangement is subject to approval. I agree to communicate with you if changes are necessary or if my contact information changes. I understand that failure to adhere to proposed/approved arrangements can void my arrangements and other action may be taken by you. *
Please type your name below to certify your agreement to the above statement.
Your answer
Today's Date *
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PLEASE READ BEFORE SUBMITTING YOUR PROPOSAL!
Thank you for completing this information. When you click SUBMIT below, your information will be transferred to us securely. We opted to utilize Google Forms for this function due to the high security systems in place that allows the information you submit to transfer directly to us without leaving a secure connection from start to finish. This is an attempt to collect a debt and any information obtained may be used for that purpose.
A copy of your responses will be emailed to the address you provided.
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