This is an attempt to collect a debt and all information will be used for that purpose.
Authorization to Visit with Third Parties
If you wish to permit us to visit with a third party about your account we must first have your permission. You are also authorizing this individual to make payment arrangements for you. If you wish to give us that permission please complete the following information and mail or fax it to our office.
After printing this form and filling it out you may mail or fax it to us. Please use the information listed at the bottom of this page.