Guest Payments

One-time Payment by Check

 

Date
Customer IP
Account Number*

(referenced on your billing statement)

Confirm Account Number*

(Incorrect or partial account number may cause delay or denial of payment)

Payment Amount*
No Fees to pay by Check
Total Payment
Name as on Check*
Bank Routing Number*
Bank Account Number*
Check Number*
First Name*
Last Name*
Address*
Address 2
City*
State*
Zip*
Phone Number*

 

 

Receive a Confirmation (yes/no)*

   If you selected 'Yes' be sure to enter a valid email address below in order to recieve a payment confirmation.

Enter Confirmation Email Address

   If you do not receive your confirmation, contact the billing department before making another payment.

 

Check Authorization*

Check Authorization: You must be authorized to sign the check. By selecting 'I Agree' and submitting payment information through this Service you agree to the terms and conditions of this Agreement and any documents incorporated by reference. You further agree that this User Agreement forms a legally binding contract between you and AR Billing Services and that this Agreement constitutes "a writing signed by You" under any applicable law or regulation. Any rights not expressly granted herein are reserved by AR Billing Services. By selecting 'I Agree" and 'Submit Guest Payment' I understand that my check will be presented to my bank electronically. After you Submit Payment the check will be submitted to AR Billing Services and you will not be able to make changes without contacting AR Billing Services. I understand unless prohibited by State law or statute a return check fee of $30.00 will be charged to your account for not sufficent funds (NSF). Please save or print this authorization for your records.

Please verify your account and payment information before submitting a guest payment. Incorrect information can cause denial or delay of payment. Refunds will be submitted on over-payments by mailing a paper check and once those funds have been received.  EFT Banking can take up to, but not limited to, 15 business days to fully process (funds are received by our bank). We can not put a stop on an EFT payment once submitted, you must contact your bank. If you are not sure the guest payment completed, please contact the billing department before submitting another guest payment. If you make a double payment, each payment will be applied to your account/balance due.