Request For Payment Agreement
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Request For Payment Agreement Form. This is a Texas form and can be use in Alcoholic Beverage Commission Statewide.
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Tags: Request For Payment Agreement, C-44, Texas Statewide, Alcoholic Beverage Commission
Form C-44 (12/2004)
REQUEST FOR PAYMENT AGREEMENT
To:
Director of Compliance
From:
Tradename:
CLP Number:
Address:
City:
Zip Code:
Mail Address:
City:
Zip Code:
Personal Guarantor(s):
1.
Name of Individual/Institution
Address
City/State/Zip Code
2.
Name of Individual/Institution
Address
City/State/Zip Code
Analysis No.
of the above described permit, covering the period from
to
established delinquent fees in the total amount of
Of this amount,
has been paid leaving a balance of
.
We have applied to at least two different lending institutions located in the State of Texas for a loan to pay the
balance. Each has rejected our application. Therefore, we are filing this “Request for Payment Agreement” for the
Commission’s consideration. We understand this is only a request and that the Commission may accept or reject
the request in part or in its entirety.
Attached for your consideration are:
1.
Form C-43, Overview to Request For Payment Agreement.
2.
Notarized copies of the loan application presented to:
Name of Financial Institution
Name of Financial Institution
3.
Loan refusal letters from said institutions.
4.
Payment Agreement.
PERMIT OFFICER
TITLE
NAME OF INDIVIDUAL
SIGNATURE
DATE
PERMIT OFFICER
TITLE
NAME OF INDIVIDUAL
SIGNATURE
DATE
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