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Account Information

Account number

Memo

Payment Information

First name

Last name

Bank account number

Confirm Bank account number

Check number

Bank routing number

Bank account type

Address 1

Address 2

City

State

Country

Zip

Zip plus 4

Email address

Phone number

Payment ($)

You are agreeing to pay $ plus a Fee of $ (%) for a Total of $.

Number of Payments: 0

Confirmation

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I authorize M2 Law Group PC to debit the above payment of $ from the bank account listed above. I also authorize M2 Law Group PC to store this information in compliance with payment processing regulations and to debit the bank account listed above for future payments in accordance with their terms. I understand that to make any changes to this authorization I must contact M2 Law Group PC prior to the payment being submitted to process.

I authorize M2 Law Group PC to debit the payment schedule outlined from the bank account listed above. Each payment will be processed on or after the scheduled date. I also authorize M2 Law Group PC to store this information in compliance with payment processing regulations and to debit the bank account listed above for future payments in accordance with their terms. I understand that to make any changes to this authorization I must contact M2 Law Group PC prior to the payment date.

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