Authorization for Bank Draft Installment Agreement

This notice is sent to complete the authorization to pay an installment payment agreement by bank draft. You must sign and return the notice within 15 days of the date on the notice.











What should I do?

Sign and return the entire notice within 15 days of the date on the notice. If we do not receive the notice within 15 days, your agreement will automatically be in default.

If your agreement goes into default, we may begin forced collection actions immediately. Examples of forced collection actions could include:

  • Deducting 10% of your wages paid before deductions
  • Freezing funds in your bank account
  • Seizing personal or business assets
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Where can I get more information?

For more information, review the installment payment agreement page. If you have additional questions, call 1-877-252-3252.

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When will my first payment be drafted?

The first payment draft date is listed under the heading Important Terms and Conditions of This Agreement.

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What if I need to make a change?

Any changes to your agreement must be made 10 business days before the next installment due date.

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