Secure Online Check Payment

Name on Check *

Address On Check *

Bank Name *

Bank City & State *

Check Number

Account Number *

Account Number (Confirm) *

Routing / ABA Number *

AAS Account # *

Contact Phone # *

Amount *

Authorization *

I authorize AAS Debt Recovery Inc. to draft my checking account for the amount listed above.

AAS Debt Recovery Inc.
P.O. Box 129
Monroeville, PA 15146

Phone: 412-829-0624
Fax: 412-829-1154
Toll Free: 1-888-829-0624