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Time Pay Agreement for Infractions

Whatcom County District Court
Address:311 Grand Ave., Suite 401, Bellingham, WA 98225 Phone: (360) 778-5400
Agreement must be submitted within 30 days of the violation date of the infraction. If over 30 days, contact the Court at (360) 778-5400 for options.
Instructions:
Please fill out all fields to request a payment plan at $25.00 per month. You will receive a response from the court within 3-5 business days. A one time $10.00 time pay fee will be added to each infraction that is set up on a payment plan.

All fields below are required
First Name*
Last Name*
Date of Birth:*
Date of Birth:
Phone Number: *
E-Mail Address: *
Infraction Number:*
I agree that I have committed, or the Court has ruled that I have committed, the listed infraction(s) and I request a payment plan. I understand that if a payment is not made as agreed, this may result in a suspension of my driver's license until the original penalty, a $52.00 assessment, and any collections fees have been paid in full. I understand a one time $10.00 time pay fee will be assessed on each listed infraction.
I further understand that it is my responsibility to keep the court informed of my current mailing address.

I certify (or declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.

I understand that if this form is submitted electronically, my typed name on the signature line will qualify as my signature for purposes of the above certification.

I have read and accept all of the conditions noted above.
Date (Today's Date):*
Date (Today's Date):
Place Signed / Submitted (physical location of where you are submitting this form):*
Signature (Please type in your name):*

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Time Pay Agreement for Infractions