Web Payment

Credit Card Payment

To ensure payment gets applied properly, please provide the following information:
Did you receive a letter from us?*

YesNo
Debtor ID / Ref # / Case #*
Current Creditor
See link above payment form to find out how to locate your Debtor ID # and / or Original Creditor
Name on Account You are Paying*

First NameLast Name

Payment Amount*

USDEnter Payment Amount

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Company Name (if applicable)
Phone Number*
Email Address*
example@example.com
Check Box to Authorize Charge
Please place initials below to Authorize Charge:

I certify that by clicking 'Submit' that I approve the above charges. I authorize McKenzie Paul and Associates to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. I also agree that the electronic signatures, whether digital or encrypted, included in this Authorization are intended to authenticate this writing and to have the same force and effect as manual signatures. Delivery of a copy of this Authorization or any other document contemplated hereby bearing an original or electronic signature by facsimile transmission (whether directly from one facsimile device to another by means of a dial-up connection or whether mediated by the worldwide web), by electronic mail in “portable document format” (“.pdf”) form, or by any other electronic means intended to preserve the original graphic and pictorial appearance of a document, will have the same effect as physical delivery of the paper document bearing an original or electronic signature.
Initials - I accept the above statement and authorize the charge*
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Credit Card Payment