Submit a Secure Payment by Credit Card

Credit Card Example

This site is for a collection agency. We are attempting to collect a debt and any information obtained will be used for that purpose.

We accept Visa & MasterCard.

Your Account Number *Located on the upper left of our collection letter
First Name *Name our letter was addressed to.
Last Name *Name our letter was addressed to.
Exact Payment Amount *($1000.00) format. A $3.00 service fee will be added.
Credit Card Number *Please enter your 16 digit credit card number with no spaces/no dashes.
Expiration Date *
CVC Code *Please enter the 3 digit security code on the back of the card.
Credit Card Billing Address *
Please enter the credit card billing address.Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Name on Card *Please enter the full name on the credit card.
Phone Number *
Authorization *
I hereby declare that all of the information submitted is accurate and provide my authorization to process this payment. I authorize HSA card transactions to be processed by the original creditor. If I request a chargeback with my credit card company, I may be assessed a $25 fee.
Additional Notes (Optional)
If you wish to have this payment applied to certain creditors, please note the creditor's name(s); otherwise we will apply the payment to the oldest account first.

Please enter any two digits to verify this is a valid payment submission *Example: 12
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REQUIRED STATEMENT:

This site is for a collection agency. We are attempting to collect a debt and any information obtained will be used for that purpose.