Agreement To Pay printable pdf download

AGREEMENT

(this is a legal document)

11-10-11

Date ____________

I (we) ____________________________ and ______________________________

agree, joint and severally, that we owe this amount and to pay to the holder of this agreement

(A)

$______________ (________________________________________________), as follows:

1. on or before____________, 20_____,

2. Or on the following Payment Schedule:

Amount $__________ due on ___________, 20_____,

3. Or $_________ each ______________________, beginning ________________.

(B)

We agree to vacate the property on or before NOON, (date) _______________

We agree to leave the home clean. Any cleaning and repairs may be added after move-out. Any items

remaining after this date may be disposed by management.

This form also serves as the state required deposit settlement. Collection, legal, court fees, etc will be

added to the total shown.

(C)

Permanant Forwarding address: I/we authorize all legal notices to be sent to this address.

_________________________________________________________________________________

Phone__________________________________ _________________________________

Employment ____________________________

_________________________________

Money order, or bank draft only. Delivered to Grayson Management, 3129 25th St #202, Columbus IN 47203.

Returned check fee: $50. $5.00 per day late fee applies to payments not received on the dates shown above.

Attorney and legal fees may be added to this amount.

15% interest on unpaid balance.

If I/we do not fulfill this payment plan, I/we agree to wage garnishment(s) of $150 per month or bank draft, and

per Indiana Code IC 32-31-5-5(b):

In consideration of extending credit, (i.e. unpaid rent, repairs, etc) we reserve right to deposit a bank draft to pay past due

and other unpaid invoices & late fees. If bank draft(s) are returned for any reason you agree to pay a 20% penalty fee.

These terms supercede all other previous verbal or written agreements between parties. If you do not agree with these

terms or lack authority to accept them, return goods (or vacate property) within 10 days to Point of Origin.

Waiver of Counsel: I/we do not have an attorney and are signing voluntarily.

_____ Pay with Automatic Bank Draft Routing __________________

Acct _________________________

_____________________________

______________________________

__________

Signed

Print Name

Date

_____________________________

______________________________

__________

Signed

Print Name

Date

Agreement To Pay

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