Ragan & Ragan

Ragan & Ragan PC
Single Secure Payment Form

Order Summary:

Charge Date:

10/12/24

Charge Amount:

R&R File No.

To process your payment enter
your 8-digit R&R file number only

If you do not know your R&R File Number please contact us at: service@raganlaw.com or 732-280-4100

WE DO NOT ACCEPT AMERICAN EXPRESS. IF YOU ARE A CONSUMER WHO RESIDES IN GA goto www.raganlawga.com to make payment.

WE ALSO DO NOT ACCEPT VISA CREDIT for the repayment of debts. You may pay by VISA DEBIT. If you are paying by VISA CREDIT to pay a debt, PLEASE STOP and do not process your payment and contact our office at us for this information: optout@raganlaw.com or 732-280-4100

for this information.

Customer IP:

98.84.18.52

Credit Card Information:

Card Type:

Name as on Card:

Card Billing Zipcode:

Card Address (No city or state):

Card Number:

Card Expiration Date:

(MMYY)

Card ID (CVV2/CID) Number:
[What is the Card ID?]

THE FOLLOWING INFORMATION IS NECESSARY TO PROCESS YOUR PAYMENT

Debtor/Customer name:

Contact Tel. No.:

Debtor/Customer email:

Other:

Terms of Collection (Must be checked to proceed)
I understand that Ragan & Ragan, PC is a law firm debt collector and that this is an attempt to collect a debt and any information obtained will be used for that purpose. If you are paying by VISA you acknowledge that you have been provided with the name of the original creditor, the original account number, a description of the debt and the date of the date of repayment contract. If you have not do not process your payment and contact us at visa@raganlaw.com or 732-280-4100 for this information. I authorize Ragan & Ragan PC to debit my credit card as indicated above for the above indicated amount. I certify that I am authorized to initiate transactions on this account. I agree that I will not dispute Ragan & Ragan PC charging my credit card, so long as the amount and debit date corresponds to the terms indicated in this agreement. You may be asked to execute a formal settlement agreement by way of Stipulation, Consent Order or letter agreement. You may also be asked to execute a formal recurring payment affidavit. In the event that you are asked to execute and return a formal Stipulation, Consent Order, letter agreement or formal recurring payment affidavit this transaction will not be considered complete until an originally signed copy of the requested document is received by this office. I also acknowledge, understand and consent to Ragan & Ragan, PC communicating with me by email, cell phone and/or text message. If you do not consent to communication with Ragan & Ragan, PC by email, cell phone or text message do not process this payment and email optout@raganlaw.com. It is further understood, acknowledged and consented to that I will receive a return email acknowledging this payment regardless of the time of day. That means if you do not consent to a return email confirmation, outside of 8am and 6pm local time do not process this payment and email optout@raganlaw.com. I also acknowledge and understand that I may select to call in each individual payment on my own or make payment by other acceptable means. If payment is being made by a non-debtor, the debtor in question does hereby authorize Ragan & Ragan, PC to communicate with this third party non-debtor payer. If payment is being made by a non-debtor, the third party non-debtor payer authorizes Ragan & Ragan, PC to charge their credit card as set forth. The Debtor further acknowledges and understands that he has had the opportunity to review this settlement with an attorney of his choosing and that this is a binding agreement and that there will be no payment exceptions or extensions. Ragan & Ragan, PC is not required to renew or extend any payment plans or settlements. If you do not understand or agree to any of that which is set forth above do not check the Terms of Collection box and do not proceed with payment. If you do not understand or agree to any of the forgoing please contact this office at 732-280-4100 to discuss this further. By checking the Terms of Collection box you acknowledge your understanding of the forgoing and agree to the terms set forth.