Payment Offer

Cause Number

Please enter your case or cause number that is on the Summons you received from the Court.

Name

Last

Street Address *

City, State Zip Code *

Email *

Contact Phone No

Last four SSN *

Date of Birth

I wish to:

Offer Settlement Amount Offer Installment Payment Amount

Amount of Payment or Settlement

Choose a settlement amount that is reasonable and within your ability to pay at this current moment. Choose an installment payment amount that is a minimum of 10% of your monthly income and you can reasonably expect to pay on time every month. An installment payment plan will require 1st payment at time of agreement and payments received 5 days after due date will void installment payment plan and initiate wage garnishment withholdings.

Frequency of Payments

Weekly Bi-weekly Monthly

When can you make first and subsequent payments?

How would you like to submit payment?

Auto Debit Bank Account Make Payment on GRT Website Mail Monthly Check or Money Order

For those choosing Auto Debit, we will mail you an auto-debit authorization form for you to complete and return. You will be able to state when, how often and how much to debit from your account. You may terminate auto-debit plans at any time by calling us.

Special notes or considerations that you would like to state?

ALL PAYMENT OFFERS MUST BE ACCOMPANIED BY A PAYMENT TO BE CONSIDERED. PAYMENT MAY BE MADE IN ONE OF THE THREE MANNERS ABOVE. A PAYMENT DOES NOT GUARANTEE YOUR OFFER WILL BE ACCEPTED; WE WILL CONTACT YOU AFTER CONSIDERATION TO APPROVE OR DENY THE REQUEST. Upon submission of this Payment Offer, you will be redirected to our online Payment Portal to submit payment. This is optional and for your convenience only.

Please type your name or initials as you would normally sign a document to acknowledge you read and understand this document.

FDCPA Compliancy

Green, Richard and Trent is a licensed and professional collection agency. We are respectful of others and compose our business in a manner of respect and dignity to all. As such, we are cognizant to the rights of debtors and remain fully FDCPA compliant at all times.

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