Burton Neil & Associates P.C. - Make A Payment On Your Account

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Please fill out the form below to submit your payment information online.
If you would prefer to make a payment by phone, please call us at 866-696-2120.

Payment Form

Your Information

Bank Information

	* Required
* Our File #	Our File #:
* First Name	First Name:
* Last Name	Last Name:
* Last 4 of SSN	Last 4 of SSN:
* Street Address	Street Address:
* City	City:
* State	State: Your state not listed?
* Zip	Zip:
Phone	Check for phone contact:You may contact me by phone regarding this payment Phone:
Email	Check for Email:You may contact me by email regarding this payment Email:
* Payee	Creditor Name: (name of creditor you are paying)
This is an attempt to collect a debt, and any information obtained will be used for that purpose. This communication is from a debt collector.

* Name(s) on Check

Name on Check:

* Bank Name

Bank Name:

Bank City

Bank City:

* Bank State

Bank State:

* Bank Routing Number

Routing Number:

* Bank Account Number

Bank Account Number:

Payment Information


* I am: (select one)	One time payment:making a one-time payment Recurring Payment:offering to set up recurring monthly payments

* Monthly Payment Amount $	Monthly Amount:
* Number of Payments	Number of Payments:
* First Payment Date	First Payment Date:

Payments will be processed within two business days from the date selected. Recurring checks will be posted to your account on the same day of the month you selected for the payment due date. If you selected the 31st day of the month, for months less than 31 days, payments will be posted on the last day of that month.



By submitting this form, I acknowledge and agree that Burton Neil & Associates, P.C. may contact me with respect to this payment. Acknowledge Submit:I understand that this is an offer and subject to approval.