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I understand that, if my account is referred toa collection agency, the collection fee is ordinarily fifty percent (50%) of the total outstanding balance due, for which I will be responsible in addition to the principal debt due and payable.  \nI have carefully and completely read this agreement and fully understand the purpose, intent and effect of this agreement. I have voluntarily executed the agreement by action of my own free will.  \nDate   Signature","cbCailfaHZczuKtc","https://ap.wps.com/l/cbCailfaHZczuKtc","pdf",93708,"English","# Promise to Pay Agreement\n## Debt Acknowledgment and Payment Obligation\n## Payment Direction and Contact Updates\n## Returned Payments and Delinquency\n## Additional Payments and Missed Payment Fees\n## Attorney Fees and Collection Costs\n## Signature and Date","[{\"question\":\"What does the signer acknowledge by signing the agreement?\",\"answer\":\"The signer acknowledges and reaffirms an outstanding debt related to fees/fines and agrees to pay it under the listed schedule terms and conditions.\"},{\"question\":\"Where must payments be made and what updates are required?\",\"answer\":\"Payments must be made payable to North Broad Family Dental. The signer is responsible for notifying the dental office of any address, phone number, or email changes.\"},{\"question\":\"What happens if a payment is returned by the bank?\",\"answer\":\"If a payment is returned for reasons such as insufficient funds or stop payment, it may cause the account to become delinquent and be placed in a collection status, potentially involving referral to a collection agency.\"},{\"question\":\"What fees and costs apply if payments are missed or sent to collections?\",\"answer\":\"Each missed payment results in a $75.00 fee. The signer also agrees to be responsible for attorney fees and reasonable collection costs, and if referred to a collection agency, the collection fee is ordinarily 50% of the total outstanding balance due.\"}]","Promise to Pay Agreement - North Broad Family Dental - Payment Schedule and Collection Terms | PDF",1789575552]