Payment Authorization Form

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Payment Authorization Form

Step 1: Gather the following information:

Step 2: After you fully complete this form, you will receive an email with a link to a customized document to sign.

If you have any questions please contact us at 860.200.8495.

By providing an email address when you submit this form you authorize us to communicate with you at the email address provided.

Email *

Where do I find my Bank Account and Routing number?

Here is an example of where to find your Bank Account & Routing Number. If you don't have a check, we suggest calling your bank for assistance.

File Number *

Your File Number can be found in the bottom of every document you have from us, see the diagram below.

Still not sure? Call us! (860) 200-8495 or Email at info@laurelwreathacq.com

Full Name *

Name associated with Laurel Wreath Acquisitions account

Date of Birth (DOB) *

DOB associated with the Laurel Wreath Acquisitions account.

YYYY

Last 4 (four) digits of your Social Security Number *

SSN associated with the Laurel Wreath Acquisitions account.

This number will be used to help verify your identity and account in order to proceed to the next step.

LAUREL WREATH ACQUISITIONS, LLC IS A DEBT COLLECTOR

Telephone (860) 200-8495

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