* Community: [ required ][ 2 char min ]

PAYMENT PLAN FORM USE
The payment plan form should be used to apply for a payment plan. A payment plan is a last resource when you are having financial difficulty because of a proven hardship and are unable to pay your dues in full. Please be sure to read the terms of the plan listed below before authorizing your signature.

YOUR CONTACT INFO

* Full Name: [ required ][ 2 char min ]

* Address: [ required ][ 2 char min ]

* City: [ required ][ 2 char min ]

* State: Select A State... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming [ required ]

* Zip Code: [ required ][ invalid format ]

* Home Phone: [ required ][ invalid format ]

* Work Phone: [ required ][ invalid format ]

* E-Mail Address: [ required ][ invalid format ]

* Confirm E-Mail: [ required ][ email must match ]

THE DETAILS

* Describe Reason: [ required ][ 5 char min ]

TYPE OF REQUEST
(Select Only One)

Hold (NO LONGER THAN 30 DAYS)  [ select one ] 4 Month Payment Plan 6 Month Payment Plan

* Monthly Payment Amt.: [ required ][ 2 char min ][ invalid format ]

By submitting this application I agree to pay the balance (amount owed) on my account and also agree to keep current on my payment plan. I understand that payments are due on the first (1) of each month and late on the fifteenth (15). My account will be charged interest and a collection fee (of up to a $20) each month until I am paid in full. I understand the Association will pursue legal action to collect the debt if I default on this payment plan. I acknowledge and understand this is an attempt to collect a debt, and any information obtained will be used for that purpose. This form will be reviewed and a letter will be mailed back to you indicating whether or not you are approved. If you are approved the letter will state the amount due each month and a paid-in-full date.

SIGNATURE

* Signature: [ required ][ match name ]

* I AGREE [ required ]

By checking the box above I agree to have read and understand all the terms and conditions listed on this form and authorize my signature.