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Collection Services of Athens Inc

Secure Payment Form


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


** Online payment transactions may not be posted to our system until the following business day. **


Please note: If overpayment is discovered a refund check will be issued within 30 days. If there is any question about a refund, please contact our office at 706.549.2263.
* Indicates a required field.

Payment Date
Amount
RP Number
CSA Account Name *
Notes
Name as on Card
Card Billing Address
Card Billing Zip
Card Number
Card Expiration Date
CVV2/CID

By submitting payment information through this service you agree to the terms and conditions of this agreement and any documents incorporated by reference. You further agree that this User Agreement forms a legally binding contract between you and Collection Services of Athens, Inc., and that this Agreement constitutes a writing signed by you under applicable law or regulation. Any rights not expressly granted herein are reserved by Collection Services of Athens, Inc. By click on the Submit button you are accepting these terms and stated fees for using this service. Please remember to print this page and the following page for your records.

Name as on Check
Bank Routing Number
Bank Account Number
Social Security Number
Drivers License Number
Drivers License State

By submitting payment information, you are authorizing Collections Services of Athens, Inc. to reproduce this item as an ACH transaction for deposit on the date specified above. A transaction that is returned to Collection Services of Athens, Inc. for for any reason may be subject to a returned item fee by your banking institution. An ACH transaction will be produced utilizing the information from this form you are submitting. You also authorize subsequent attempts to clear this transaction if the original is dishonored or returned for any reason. By clicking the Submit button you are accepting these terms and conditions and the stated fees for using this service. Please print a copy of this and the following page for your records.

First Name
Last Name
Address
Address 2
City
State
Zip
Phone Number