Client Payout Adjustment & Agreement Setup

Use this form to securely enter client details and structured payout information. Submitted data will be used to generate the official Partnership Adjustment & Structured Payout Agreement and deliver it to the client for review and signature.

Client Name *

Client Phone *

Client Email *

OPTION A

Adjusted Payout Plan

Payment 1

Payment 2

Payment 3

Payment 4

Payment 5

Payment 6

OPTION B

Remaining Balance Due

$

Bonus Added for Option B

$

New Total Balance

$

Current Remaining Term (in months)

Months Extension

New Total Term (in months)

New Monthly Installment Amount

$

OPTION C

Remaining Lump Sum Balance Due in 6 Months

$

Bonus Added for Option C

$

OPTION D

Decline Offer