Payments


	Download Fax Agreement If you would like to download our printable version of Debt Consolidation agreement, [click here]. This form can then be faxed into our helpful representatives.


	Client ID Number:


	Amount:


	Date to deduct payment:


	One time


	Monthly


	Name:


	Address:


	City, State, Zip Code:


	Phone Number:


	Email Address:


	Bank Name:


	Routing or Transit Number:


	Account Number:


	All numbers on bottom of check:


	Additional Comments


	Terms and Conditions: By utilizing this "Online Payment" form I authorize Landmark to draft my bank account for the "Amount" as shown on this form. You acknowledge that you are the owner or authorized signer on the account information entered.



		All information is transmitted securely and kept confidential.

Landmark Consumer Credit Services
4699 North Federal Highway, Suite 107
Pompano, FL 33064

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