Adam L. Cleveland, P.C. Payment Website >> Payment Page

This is the payment processing website for Adam L. Cleveland, P.C. (“ALC”).

ALC operates as a debt collector attempting to collect debts. Any information obtained will be used for that purpose. By using this website, I acknowledge that, even though I am making a payment, ALC and/or its client(s) may still initiate or continue legal proceedings against me unless we have agreed specifically to forbearance from or discontinuation of such action(s). As consideration for ALC offering the option to pay in this manner and Everybill, LLC providing the means to use that option, I hereby waive any and all claims of liability I may have against ALC or Everybill, LLC, and agree to indemnify and hold both harmless from any loss or claims of liability, from any source, arising in relation to or resulting from my use of this website. I also agree to waive, and release and hold ALC harmless from, any claim(s) I may have pursuant to 15 U.S.C.A. § 1692 et seq. as well as any claims I may have under any applicable state laws, statutes, ordinances, restrictions, or regulations of any kind.

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Please enter all the required information:

*

Name *

First name

*Last name / Company name

Address *

*Address line 1 - street, P.O. box, company name, c/o

Address line 2 (optional) - apartment, suite, etc.

*City

*State

*Zip Code

Phone *

*10 digit phone number

Email *

Email address (optional)

File *

*File Number

I don't know my file number

*Last 4 Social Security Number (SSN) digits

Creditor Name

Creditor Account Number

Bank Account Info *

*Account type

*Routing number

*Account number

*Verify account number

Bank name

Payment *

*Payment frequency

Number of payments

NOTE: All recurring payments are automatically deducted on their specified due date. Once you've scheduled the recurring payment you do not have to make any separate payments towards that payment schedule except specifically advised to do so by the company.

*Payment amount (in USD)

*Payment date (mm/dd/yyyy)

Notes *

Notes

*

Please double check your information:

I hereby understand and agree that:

My full name is firstName lastName.

Email Address: email

I am authorizing payment(s) toward File Number fileNumber.

Social Security Number (SSN): XXX-XX-altFileNumber

Creditor Name: notes_creditorName

Creditor Account Number: notes_creditorAcctNo

I have the authority to make payments from the following account:

Routing Number: routingNo

Account Number: accountNo

I understand that an amount of $amount was scheduled but will not actually leave my account until a few days after the payment was scheduled which was on effectiveDate and that I am responsible for maintaining a sufficient amount of funds in said account until that time.

By using this method of payment, I authorize Adam L. Cleveland, P.C. and its client(s) (collectively, “ALC”) to apply funds paid to any account(s) of mine according to their discretion, unless I have separately agreed, in writing, with ALC to apply such payments to a specific account or accounts.

I further understand that, unless I call Adam L. Cleveland, P.C. at (404) 736-6803 to cancel, a payment of $amount will be deducted from this account frequency starting from effectiveDate.

These payments will continue for a total of totalPayments payments.totalPayments

By using this method of payment, I authorize Adam L. Cleveland, P.C. and its client(s) (collectively, “ALC”) to apply funds paid to any account(s) of mine according to their discretion, unless I have separately agreed, in writing, with ALC to apply such payments to a specific account or accounts.

I ACCEPT

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