Make a Payment - Accounts ReceivableAccounts Receivable

Your Information

Your Company Name

Your First Name*

Your Last Name*

Address*

City*

State/Province*

Zip*

Daytime Phone*

Evening Phone

Fax Number

Email Address*

File Number*

Please Choose A Method Of Payment Below:

Credit Card Payments are subject to a 4% processing fee

Payment Method*

Electronic Check
Credit/Debit Card

Electronic Check

Provide the following Checking information

Bank Name*

Name on Check*

Routing Number*

Account Number*

Account Type*

Personal Account
Business Account

How much will you be paying today?*

(Use Numbers and Decimal Only)

Authorization for Electronic Funds Transfer(*Required)

By signing below, you authorize Accounts Receivable to make debit entries in the form of ACH transfers in accordance with the Payment Schedule. You acknowledge that the origination of ACH transactions to your account must comply with the provisions of U.S. Law and the Rules of the National Automated Clearing House Association.

Your payment will be made automatically from your designated account. If your due date falls on a weekend or holiday, your payment will be deducted on the first business day following your payment due date.

If there are insufficient funds in your account, Accounts Receivable may elect to electronically (or by paper draft) re-present your payment up to two more times. You also understand and authorize Accounts Receivable to collect a return processing charge by the same means, in an amount not to exceed that as permitted by state law. You may cancel this authorization by sending written notice to Accounts Receivable at the address above or at 877-832-2482, or by completing a new copy of this form. Accounts Receivable must be notified of revoked authorization at least 1 day prior to the payment due.

*

This authorization is valid for this transaction only. The transaction amount will be for exactly
This authorization is valid for recurring debits to my account by use of check draft.

Choose a Recurring Payment Cycle:*

Monthly
Daily
Weekly

Your checking account will be charged:

$0.00

Please keep a copy of this authorization for your records. If you should have any questions concerning your payment arrangement please contact us at the phone number listed list above.

*

Authorized Card holder Electronic Signature*

*

MM

DD

YYYY

Date*

Credit/Debit Card

How much will you be paying today?*

(Use Numbers and Decimal Only Example: 3.23)

Calculation

Total amount you will be charged*

Price: $0.00

*

By Checking this box I understand that there will be a 4% processing fee added to my payment. I understand that the total amount charged to my card/account will be

Bitcoin

How much will you be paying today?*

(Use Numbers and Decimal Only Example: 3.23)

Security Measure