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payment plan request
Payment Plan Request
First Name
Last Name
Your Postal Address
Suburb
State
Post Code
Country
Infringement Number
Please separate infringement numbers with a comma. ie 12345,12346,12347...
Agency Name
This is the name of the Council/Hospital/University that issued the infringement. This is never Bartels, Taylor & Associates.
Vehicle Registration Number
Telephone Number
Your email address
Please be advised that only the registered owner of a vehicle can request a review of an infringement. The owner must submit a Known User Statement nominating you as the driver of the vehicle or a letter of authorisation authorising you to represent them for this matter. If you have one of the requested documents from the owner, please attach it below.
Are you the registered owner at VicRoads, nominated driver or have written authority to represent the owner?
I would like
- Select a value -
An extension of time to pay
A payment plan by instalment
Do you hold a valid concession card?
How many days extension would you like to request?
- None -
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2
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30
Frequency of instalment?
- None -
Fortnightly
Monthly
Instalment Amount?
$
Each Payment Plan is different. There are minimum instalment amounts required for payment plans where the owner does not have a valid concession card and also a maximum number of instalments allowed. A good guide is to keep the number of instalments under 15.
Attachments
Add a new file
Unlimited number of files can be uploaded to this field.
2 GB limit.
Allowed types: jpg png pdf doc docx.
Acknowledgement
I understand and acknowledge that:
This document is a digitally signed statement.
It is an offence to provide false or misleading information and a penalty may be imposed under the relevant acts.
I Agree
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