FCCSA Account #:
Property Address:
Owner's Name:
Phone Number:
Current Balance:
Email:
I, , am the owner of the above referenced property and understand my obligation to pay the amount shown plus administrative, interest, and collection fees as outlined in the FCCSA Collections Policy. Since I am not able to pay the full amount at this time, I submit the following installment plan (consecutive monthly payments only):
Payment
Date to Pay
Amount to Pay
Remaining Balance
Check No. (Office Use Only)
#1
______
#2
#3
#4
*Note: Interest Fees will accrue monthly to your account per FCCSA Collections Policy
Interest at a rate of 10% per year is charged on assessments to all accounts that remain unpaid or delinquent as of the last day of each month. A monthly administrative fee of $15.00 is also applied to all delinquent accounts. (The monthly administrative fee is reduced to $0.00 for those accounts with an approved payment plan – see attached Payment Plan Policy). Formula for calculating monthly interest is as follows:
Remaining balance multiply by 10% divide by 12 (months) equals interest charge for the month Example: 758.00 (remaining balance) x 10% = 72.80 (yearly interest) 75.80 (yearly interest) ÷ 12 = 6.31 (monthly interest)
If for any reason I cannot strictly adhere to the above schedule, I understand that First Colony Community Services Association may elect to pursue legal proceedings to collect the amount due under the terms of the FCCSA Collections Policy.
If I meet the terms of this payment plan, I understand that First Colony Community Services Association, Inc. agrees to suspend any further legal actions against me to collect the amount owed. When I have fully paid off the amount owed and my account balance is zero ($0.00), I understand that First Colony Community Services Association will release any maintenance fee liens and/or judgments that may have been filed against me or the above referenced property.
* By checking this box the Entity/ Contact Person acknowledges that the information is true and correct. Applicants providing payment and personal information must agree to share the information willingly to the FCCSA and trust the information will be treated with respect and is kept confidential. Information is used only for the "Lot Coverage Form" and by no means makes the First Colony Community Services Association responsible for additional debt or liability of the applicant.
Owner's Signature:
Date:
THIS PAYMENT PLAN IS NOT CONSIDERED AN APPROVED PAYMENT PLAN UNTIL IT IS SIGNED BY FCCSA. UPON APPROVAL BY FCCSA YOU WILL RECEIVE A FULLY SIGNED COPY. IF YOU DO NOT RECEIVE ONE WITHIN 2 WEEKS AFTER SUBMITTING YOUR PROPOSED PAYMENT PLAN PLEASE CONTACT THE FCCSA OFFICE.
