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Special Payment Request

Special Payment Request
  • Please complete the form below in order to be considered for special payment arrangements. Please be advised that all forms must be submitted in advance to allow our staff adequate time to review your case. We are not responsible for any late fees that should occur due to forms submitted with inadequate notice. Please continue to make any payments as scheduled while awaiting a decision. Be advised there is a $50 processing fee added for any approved payment schedule changes.

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  • I understand that submission of this request does not guarantee acceptance, and by submitting this request, my case will be reviewed and a decision will be provided to me.

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