Quick Payment - Accounts Interchange Group, LLC

Account Information

Reference Number:

*

First Name:

*

Last Name:

*

Email Address:

*

Payment Method

Amount:

*

Payment Method:

Credit Card

Payment Information

Name on Checking Account:

*

9 Digit Routing Number:

*

Bank Account Number:

*

Name:
Address
City, State, Zip

Pay To: Accounts Interchange Group, LLC Amount: : : 000 Routing Number Account Number Check Number

Name on Card:

*

Zip Code:

*

Card Number:

*

Expiration Date

*

Security Code:

*

Please Verify Your Information

Reference Number:

******

Name:

******

Email Address:

******

Payment Method:

******

Account Payment Amount:

******

:

******

BY CLICKING ON THE SUBMIT PAYMENT BUTTON, I AGREE TO THE TERMS AND CONDITIONS OF USING MY CREDIT OR DEBIT CARD AS A PAYMENT METHOD AND I AUTHORIZE Accounts Interchange Group, LLC TO PROCESS A CHARGE FOR THE DOLLAR AMOUNT ENTERED ABOVE.

I hereby authorize Accounts Interchange Group, LLC to debit my debit or credit card in the amount specified above as payment to my account with Accounts Interchange Group, LLC for a single account, which will be processed pursuant to the terms of Regulation E; Electronic Funds Transfers of the Federal Reserve System.

I hereby electronically consent to and authorize my signature to the funds transfer authorization. I also agree that I am authorized user of the credit or debit card account that I have provided and that I am authorized to make payment on this account.

*

I Agree to the terms and conditions above