Account Receivable Solutions, Inc.


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 Electronic Check

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Pay by Electronic Check

  1. This is an attempt to collect a debt and any information provided will be used for that purpose.
  2. This information will be kept confidential in accordance with our standards.
  3. Billing and Debt Collection Services.

  

Please provide checking account information for immediate crediting/debiting.

Void your next check, then record in your ledger this check number for the amount you authorize to be applied to your account, confirmation will be sent to you 1st Class Mail.

 

Amount of Check $
(Example: 1,234.56 )

Bank's Name + Address
Name
Street/POBox/ etc.
City
State
ZIP

Check Number

Checking Account Number

Routing/Transit Number

Fractional Number

Checking Account Holder's Name

Your Name

Your Address
Street, etc.
City
State
ZIP
Telephone Number

A/R+S Account Number
if available

Your email address

 

This is an attempt to collect a debt and any information obtained will be used for that purpose.