Request A Living Expense Extension
NOTE: THIS IS FOR RECOVER REVOLUTION HOUSE MEMBERS ONLY.
Date of Extension Request:
House:
Name:
Reason For Extension Request:
Amount To Paid:
Date Expense Will Be Paid:
Time Expense Will Be Paid:
IMPORTANT
Submitting this form does not absolve you of the obligation to pay the amounts due by the agreed upon day and time. This form serves solely as a means of communication should you find yourself unable to make the payment by the due date. Please be aware that failure to meet payment obligations may result in expulsion from the house.
By checking this box, you acknowledge that you have read and understood the above information.
Signature:
By continuing, you agree that your electronic signature is the legally binding equivalent to your handwritten signature. Whenever you execute an electronic signature, it has the same validity and meaning as your handwritten signature. You will not, at any time in the future, repudiate the meaning of your electronic signature or claim that your electronic signature is not legally binding.