payment plan request

Fishman Group, P.C. is a debt collection law firm. This communication is an attempt to collect a debt and any information obtained will be used for that purpose.

Please complete the form below

In doing so, you swear and affirm the following is a true statement of your assets and financial obligations.

Name *
Name
Please contact our office by phone if you do not know our file number, toll-free at 833-215-0677.
Address *
Address
Employer information is required in order for your request to be reviewed with your creditor.
Please approximate your income after taxes on a monthly basis.
$
Employer Address *
Employer Address
Banking and/or financial institution information is required in order for your request to be reviewed with your creditor.
$
Proposed First Monthly Due Date *
Proposed First Monthly Due Date
Do you own or rent your home? *
Do you own or lease a car? *
On completion of this form, we will review any information submitted with our client, subject to the completion of this form in its entirety. Submission of this information does not bind Fishman Group, P.C. or its clients to agree to any proposed payments or settlement offers.
Phone *
Phone
In providing your phone number, you consent to our contacting you at the phone number provided.
I consent to receipt of electronic communications from Fishman Group, P.C. *
If you do not consent to receipt of electronic communications, please provide a physical address for any responses required by state or federal law or we may be unable to respond to your request.
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