AAS Debt Recovery, Inc.

AAS Debt Recovery, Inc.
Secure Payment Form

Order Summary:

Order Date:

10/23/24

Amount:*

Customer IP:

18.118.210.203

Description:

Credit Card Information:

Card Type:

AAS Account number: *

Name as on Card: *

Card Billing Address: *

Card Billing Zipcode: *

Card Number: *

Card Expiration Date: *

MMYY

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

Billing Information:

Company Name:

First Name:

Last Name:

Address:

Address Line 2:

City:

State:

Zip:

Country:

Phone Number: *

Email Address: