Online Check Payment

Please note, we do not accept Debit Card or Credit Card payments.

Please Enter Your Customer Details:

Your File Number *

See Example

First Name *

Last Name *

Street Address *

City *

State, Zip *

Phone Number *

Place of Employment

Email Address *

Verify Email Address *

Enter the Amount and Date Of Payment:

Amount To Pay *

Verify Payment Amount *

Date To Pay *

Between Now and 5 Days From Now

Enter Your Banking Details:

Bank Routing Number *

See Example

Bank Account Number *

Verify Bank Account Number *

I understand this transaction will appear as check number 9999 on my bank statement from "Klima, Peters & Daly, P.A."

I further agree that nothing within this site shall be considered as an offer to settle any matter, unless otherwise agreed to by Klima, Peters & Daly, P.A.

By clicking the "Submit" button below, I am affirming that I understand and agree to these terms of payment.

THIS COMMUNICATION IS FROM A DEBT COLLECTOR. THIS IS AN ATTEMPT TO COLLECT A DEBT BY A DEBT COLLECTOR AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.

I have read and agree to the above statement

If you would like to authorize recurring payments from your checking account, please sign, date and return this completed form along with a voided check. Please note, we will not be able to process your request without a voided check and where all the fields of the form are executed.

Online Check Payment

Please Enter Your Customer Details:

Enter the Amount and Date Of Payment:

Enter Your Banking Details:

Online

By Phone

By Mail

Please Enter Your Customer Details:

Enter the Amount and Date Of Payment:

Enter Your Banking Details:

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Payment Options

Online

By Phone

By Mail