Secure Payment Form

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Payment Summary:
Payment Date: 09/23/20
Payment Amount: (minimum $100)
File Number: (8 digits)
First Name:
Last Name:
Address:
Address Line 2:
City:
State:
Zip:
Country:
Phone Number:
Email Address:
     
           
Credit Card Information:
Name as on Card:
Card Billing Address:
Card Billing Zip:
Card Number:
Card Expiration Date: MMYY
Card ID (CVV) Number:
 
[What is the Card ID?]

By clicking Process Payment, I acknowledge and agree that Watson & Allard, PC may contact me with respect to this payment.    


This is an attempt to collect a debt, and any information obtained will be used for that purpose. This communication is from a debt collector.