What's affecting your financial situation? What's affecting your financial situation? IllnessInjuryJob lossIncome reductionLegal issuesMedical expensesNatural disasterMilitary deploymentDivorce or separationDeath of a family memberOther Explain: Do you want to elaborate? Do you want to elaborate? YesNo Additional details: What are you seeking? What are you seeking? Help with a paymentDismissal from jury duty Which type of payment? Which type of payment? RentMortgageLoanBill(s) What are you proposing? What are you proposing? Reduced paymentDeferred paymentReduced interest rateExtended payment termWaived late fees or penaltiesPartial paymentIncome-based payments For how long? Until when? Do you want to elaborate? Do you want to elaborate? YesNo The more thoughtful a proposed plan, the likelier it is to be accepted. Elaborate on what you're proposing: What's your juror ID number? Find your ID on the back of the summons you received in the mail. Do you want to enter the property's address? Do you want to enter the property's address? YesNo - I'll do it later. Enter the property's address: Street Address Address Line 2 City Please SelectAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWashington DCWest VirginiaWisconsinWyoming State ZIP Code What's your account number? What is your monthly income? $ What are your monthly expenses? $ Do you want to explain how you've tried to rectify the situation? Do you want to explain how you've tried to rectify the situation? YesNo I have attempted to rectify the situation by: Do you want to attach any supporting documentation? Do you want to attach any supporting documentation? YesNo What documentation are you attaching? Do you know the recipient's name? Do you know the recipient's name? YesNo Enter recipient's name: Do you want to enter the recipient's contact information? Do you want to enter the recipient's contact information? YesNo - I'll do it later. Enter recipient's email address: Enter recipient's phone number: Enter your name: Do you want to enter your contact information? Do you want to enter your contact information? YesNo - I'll do it later. Your email address: Your phone number: Today's date: Next Save Save and finish later
