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Click ‘Get Form’ to open it in the editor.
Begin by filling in your personal information, including your first name, middle initial, last name, and Social Security number. If applicable, include your spouse's details.
In Part 1, enter the total account balance for all periods and specify the installment amount you wish to pay. Choose a first installment date that falls between the 1st and 28th of the month.
Select your payment frequency by filling in the appropriate circle: Monthly, Twice a Month (1st and 15th), or Weekly. Ensure that your selected day corresponds with your first installment date.
In Part 2, provide your bank account information including financial institution name, account type, routing number, and account number. Choose whether it's a personal or business account.
Finally, in Part 3, sign the form to authorize electronic debits from your bank account. Print your name and title if applicable before submitting.
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