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Pay To: Diversified Recovery Bureau LLC Amount: : : 000 Routing Number Account Number Check Number
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BY CLICKING ON THE SUBMIT PAYMENT BUTTON, I AGREE TO THE TERMS AND CONDITIONS OF USING MY CREDIT OR DEBIT CARD AS A PAYMENT METHOD AND I AUTHORIZE Diversified Recovery Bureau LLC TO PROCESS A CHARGE FOR THE DOLLAR AMOUNT ENTERED ABOVE.

I hereby authorize Diversified Recovery Bureau LLC to debit my debit or credit card in the amount specified above as payment to my account with Diversified Recovery Bureau LLC for a single account, which will be processed pursuant to the terms of Regulation E; Electronic Funds Transfers of the Federal Reserve System.

I hereby electronically consent to and authorize my signature to the funds transfer authorization. I also agree that I am authorized user of the credit or debit card account that I have provided and that I am authorized to make payment on this account.

A service fee of 3.5% will be billed separately on your statement by Nuvei Commerce, our payment processor, for immediately processing your payment electronically. If you wish to avoid this fee you can select the ACH or mail payment options that are available. If you choose the no-fee method of paying by mail, please provide sufficient time for your payment to be received by our office by the due date. If your ACH payment option is restricted, you may pay utilizing a credit card or debit card or contact our office at 833-282-1326 for further assistance.

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