Submit a Payment Call Us or Fill Out the Form Below (832) 431-3651 Authorization Agreement for ACH PaymentFill out the form belowClient NameDebtor NameEmail AddressBalance DueRE: Payment Terms: The debtor company listed above authorizes Alexander, Miller & Associates LLC c/o the client listed above to draft the amounts listed below from the account listed below on the following dates:Bank InformationBank NameCityState/ProvinceName on Check or Account *Address on Check or Account *Type of Bank AccountIndividualCommercialRouting Number (ABA Number, 9 Digits)Account Number (ABA Number, 9 Digits) *Check Number (ABA Number, 9 Digits) *Draft DateDraft Amount *Draft DateMANDATORY FOR ALL INDIVIDUAL ACCOUNTS OR COMMERICAL ACCOUNTS PLEASE FAX BACK TO :281-741-5553Printed Name *As it appears on check or accountUpload fileIdentifying your account can be difficult sometimes, therefore, Please Attach a Voided Check Drag your file below or Choose FileDrag and Drop (or) Choose FilesAuthorization *I/We hereby authorize Alexander, Miller & Associates LLC or any of its operating subsidiaries to initiate ACH payment for the amounts listed herein, on the dates listed above from the checking account listed above.YesSignature *We hereby grant power of attorney to Alexander, Miller & Associates for the collection of the above account(s). Alexander, Miller & Associates is authorized to pursue the collection of all amounts owed, including any additional interest and collection fees that are legally due. Any interest or collection costs collected in excess of the original balance will be split equally between the Agency and the client (50/50). A commission will be charged on all funds collected, whether received directly by the client, settled through negotiations, or returned via merchandise. A cancellation fee will apply to any account(s) canceled after assignment to the Agency, unless the Agency determines the account to be uncollectible and has exhausted all collection efforts. This fee will be the full fee due or 15% of the outstanding balance, whichever is applicable. Additionally, a fee will be charged if cancellation occurs due to client interference after the Agency has been retained. In the event litigation is necessary, the account will be closed, and the client will be responsible for selecting their own attorney to file suit, as the Agency does not handle litigation. However, we can assist in recommending an attorney suited to the appropriate venue if needed. Both parties must agree on the selection through a signed agreement if our assistance is requested. As our attorney-in-fact, Alexander, Miller & Associates is authorized to accept payments, endorse checks, notes, money orders, or bank drafts for deposit, and retain the net proceeds due to us. Client authorization is required before filing suit or settling accounts on the client’s behalf. Remittance to the client will be processed on the 20th of each month for all funds received and cleared through the bank in the previous month, minus the Agency’s feesSubmitPlease do not fill in this field. Please enable JavaScript in your browser to complete this form.Name *Phone *Email *Services You Need *Select Required Service*Commercial CollectionsPre-Litigation CollectionsCAP ProgramOn-Site InvestigationsBusiness Debt RecoveryFree Business Credit ReportAdditional Message *CommentSend Message Debt Recovery Services Recovery Remittance Reporting Submit A Claim
