Echeck PAYMENT

LPS recommends eCheck as a preferred payment method

Your Email Address:

Your Name:

LPS Contact Name:

eCheck Details:

Routing Number:

Bank Account Number:

Bank Account Type:

Bank Account Type Checking Business Checking Savings

Bank Name:

Name on Account:

Billing Address:

Street:

City & State:

State AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code:

Phone:

Fax:

For Services On or At:

Amount Quoted:

Payment Date:

Account holder's Signature:

By re-typing my Signature and Date below, I am affirming that I am the above named person and that
I authorize LPS to charge the account listed above for the amount specified.

Re-Type Signature:

Copy fees of 20 cents per page will be incurred. I understand that additional charges may be added as they are incurred:

I Understand

Are you a Robot? If not, type the numbers
for "six zero four" in this box:

NOTE: Refund Policy: LPS is committed to providing our clients with a secure and comfortable payment system for online remittances. In the event of a billing error related to an echeck payment, LPS will provide a refund as applicable.
Understand that once LPS provides services to you, our fees are non-refundable. However, some cancellation requests may qualify for a partial refund. All requests for cancellation and/or refund consideration should be remitted in writing via email or fax to the accounting department.
Approved refunds will be credited back to the originating account. Fees are not dependent upon results.

 

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