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Installment Payment Plan Agreement

  1. payment plan header
  2. Current Business Information:
  3. Payment Options:
  4. 2020 Annual Permit Fees:
    If the monthly payment plan is selected, the first payment of the permit fee shall be due on the permit renewal date and paid monthly thereafter.

    If the two installment plan is selected, the first payment of one half of the permit fee shall be due on the permit renewal date and the second payment of the balance of the permit fee shall be due six (6) months after the permit renewal date.


    Conditions:
    Permits with a renewal/expiration date in calendar year 2020 must be paid in monthly installments no less than 8% of the annual fee or in the two installment plan option listed above and paid in full by 12/31/2021.
  5. 2021 Annual Permit Fees:
    The first payment of one half of the permit fee shall be due on the permit renewal date and the second payment of the balance of the permit fee shall be due six (6) months after the permit renewal date.
  6. Notice:
    When the first payment under the agreed upon installment plan is received by the Department, the permit shall be considered issued and valid, instead of requiring the entire fee as indicated in Chapter I, Regulation 5(a) of the Maricopa County Environmental Health Code.

    IT IS FURTHER STIPULATED BY AND AGREED BETWEEN THE PARTIES that the permit holder listed above shall make payments as specified in this agreement. If payments are not made as outlined above, the permit shall be expired and void after 30 days after a missed payment and enforcement action may be taken against the operating permit.
  7. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  9. This field is not part of the form submission.