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* Mandatory question please answer
*** Please enter council tax account number
*** Please enter a valid council tax account number
*** Please enter name
*** Please enter Address
*** Please enter Address of debt
*** Please enter telephone number
*** Please enter Email Address
Please indicate what INCOME you/partner receive and how often.
If you have any income not included in the list please add.
*
*** Please ensure the income is specified, the amount is in the format 0.00 and the frequency is selected.
Please indicate what household EXPENDITURE there is.
Please keep regular payments separate to any arrear payments.
Add any other expenditure not included in the list.
*** Please ensure the expenditure is specified, the amount is in the format 0.00 and the frequency is selected.
*** Please enter a valid amount
*** Please select a frequency
Before you submit this form please ensure you have read the it very carefully to make sure you have filled it in to the best of your knowledge.
When you submit the form you will be sent a copy of the information you have supplied us.
We will consider your repayment offer and contact you to confirm whether it is acceptable.
In some circumstances we may ask for further information or evidence of your financial circumstances.
We aim to respond to this within ten working days of receipt.
Please enter a valid email address
Please enter a valid telephone number
An error has occured while entering your application please try again.
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