Ph. (801) 748-4747
Toll-Free: (877) 318-4747

Offer a Settlement

Lump Sum Settlement Offer Form

Or Click Here to Make a Monthly Payment Offer

In order to assure that your settlement offer is properly received and accurately applied to your account you must fully complete the top portion of this form. Your email address and phone numbers are critical to follow up should we need additional information from you.

This firm is a debt collector. This is an attempt to collect a debt and all information obtained will be used for that purpose.

Please call our office at (801) 748-4747 or toll free at (877) 318-4747 for more information.

Please provide the following information:

First Name:
Last Name:
Home Phone:
Work Phone:
Email:
Address:
City:
State:
Zip Code:
Reference Number:
Current Creditor Name:

Lump Sum Settlement Offer Form

This is an amount that you would like to offer our client as ‘settlement in full for less than full payment’ on your account.  This offer is not yet accepted by our client.  Please do not make payment until we advise that it has been accepted.  If accepted, the amount will need to be paid in full to our office in one installment.  We will advise you of the deadline for payment.  If payment is not received in our office by that time, the full balance will become due, less any partial payment applied.

Amount you are offering as a lump sum settlement $ (enter dollars and cents):
Date by which you are proposing to pay the settlement in full (Use mm/dd/yy format):
Additional information or comments:

Authorization: I understand that this offer of settlement or proposal for a payment plan is not effective until Constantino Law Office, P.C. communicates acceptance of my offer or proposal. In addition, I understand that if my offer or proposal is accepted, that all payments must be made in the agreed amount, and must be received by Constantino Law Office, P.C. by their due date, or Constantino Law Office, P.C., at its option, can declare the settlement offer or payment proposal withdrawn. In that event, the full remaining balance will be due, and any payment made on the account thereafter will be applied against the full balance. Constantino Law Office, P.C. may contact me by e-mail or phone regarding this matter.

Yes, I do understand and agree to all of the terms above. 

You may contact me by email or phone regarding this matter.


Constantino Law Office, P.C. | 8537 S. Redwood Rd. Suite D | West Jordan Utah, 84088 | Phone: (801) 748-4747 | Fax: (801) 748-4713

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