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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:


Date to deduct payment:

One time




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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