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Account Information

First name

Last name

File No. or Last 4 of SSN

Name on acct if different

Address 1

City

State

Zip

Email address

Phone number

Payment Information

Payment ($)

Payment type

Card Check

Bank account number

Confirm Bank account number

Bank routing number

Check number

Bank account type

Are you human?

I authorize Perry Law Office, P.C. to debit the above payment from my bank account listed above. I understand that this authorization will remain in full force and effect until I notify Perry Law Office, P.C. by telephone that I wish to revoke this authorization. I understand that Perry Law Office, P.C. requires notification prior to its submission to the Automated Clearing House Network in order to cancel this authorization.

THIS COMMUNICATION IS FROM A DEBT COLLECTOR. THE PURPOSE OF THIS COMMUNICATION IS TO COLLECT A DEBT. ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. By clicking on the "process payment" button below, you agree & acknowledge you are making a voluntary payment to Perry Law Office, P.C. ("PLO") a debt collector attempting to collect a debt. I agree I am liable for any fee due to a NSF/declined/stopped payment. This voluntary one-time payment does NOT stop/prevent collection efforts by PLO, including but not limited to current or future court dates, garnishments, other payment arrangements, or other means of collections. This payment is a voluntary payment made by you regarding the debt PLO is attempting to collect and acceptance of this payment is not acceptance of a payment-in-full or settlement of your account. If you have a court date set, immediately contact PLO or you MUST appear. For questions/changes/settlements or exact balance contact PLO 260.483.3110

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