The Value Plan offers you the opportunity to collect for a flat fee of $16.50 (Phase I). All payments will be paid direct to you in Phase I so it is important to report all payments before the accounts move to Phase II. Please use the Payment Notification Form to report direct payments both in Phase I and Phase II. Social Security number is very important in terms of final recovery; please provide if available.
PRIMARY DEBTOR INFORMATION
Debtor (Brother/Sister) Name
Total Amount Due $
Date of Service
Address (parents if available)
City
State
Zip
Social Security #
Debtor Phone # A/C
Employer Name and Phone (if available)
Brief Description of Debt
CO-SIGNER INFORMATION
Co-signer Name
Co-signer Address
City
State
Zip
Co-signer Phone
Co-signer Social Security # (if available)
Relationship to Primary Debtor
Special Information regarding co-signers: if there is a co-signer, usually the parent/guardian, it is very important to provide this information as the ultimate collection is the responsibility of either the brother/sister or their co-signer. PB staff will attempt collection from both parties so chances of collection are enhanced considerably. If you submit the co-signer information we must have a copy of the signed agreement with your fraternity or sorority (attach to the account assignment form).
