Form De 999d - Installment Plan Agreement
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1INSTALLMENT PLAN AGREEMENT
Log No. _________________
Name _____________________________________ Account Balance __________
DBA ______________________________________ Amount of Offer ___________
Account No. ________________________________ Date ___________________
I promise to satisfy the amount offered, by paying the sum of $ _________________ .
I understand that the initial payment of $ ____________ is due on ______________ .
Subsequent installments in the amount of $ _____________ will be paid on the same
day of each succeeding ____________________________ until the entire amount
has been paid in full.
I further understand that failure to pay as promised will result in termination of the Offer
in Compromise, and monies paid to the Employment Development Department will be
applied against the total liability.
I certify that I have read and fully understand the conditions and terms of this agreement
as stated on the Installment Plan Information Sheet.
By ____________________ Title _________________
Date _________________
(over)
DE 999D Rev. 1 (1-15) (INTERNET)
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CU
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Parent category: Legal