(866) 401-5809

Remittance & authorization

Pay a balance

Complete the slip below and sign it. Card entry is handled by our card processor, so no card number reaches LRG Associates or this site.

Account number

Printed at the top of the notice we sent you.

Amount enclosed

$

Pay the balance in full or whatever you can manage today.

I

Cardholder of record

First
Last
City, state and ZIP *
City
State
ZIP
Where to send the receipt *
Email
Phone
II

Card

Card number *
Expires and security code *
Expires
Security code

Debit or credit. These three fields belong to our card processor — the number is tokenized before anything is sent.

III

Terms of this authorization

I direct LRG Associates, the billing office for the account number on this slip, to apply one charge to the card entered above, in the amount written above, today. The charge reads on my statement as LEGACY RECOVERY GROUP.

I confirm that the balance under that account number is mine and stands owed as of today, and that I am paying of my own accord. Where a charge matches these terms, I will bring any concern to LRG Associates first rather than to my bank or card issuer.

Should this charge be returned or charged back, the balance stays open and any fee passed on to us may be added to it. We will reach out to arrange a replacement payment before anything further happens.

This slip, together with the confirmation that follows it, stands as the record of this payment. For anything else, reach LRG Associates at (866) 401-5809 or support@lrg-associates.net, Monday – Friday, 8:00 AM – 4:00 PM PST.

I, —, authorize LRG Associates to charge $0.00 to the card entered above, one time, on November 1, 2026, toward account number —.

Signature of cardholder

Sign on the line with a mouse, trackpad or finger.

Nov 1, 2026
Dated
Total to charge $0.00

Charged once, the moment you authorize.

Once you authorize

  1. The card is charged a single time for the amount on the slip.
  2. A confirmation with the transaction number appears here.
  3. A copy of this signed slip is filed against the account.
  4. Your balance is updated the same business day.

Rather not pay online?

Call (866) 401-5809 or write support@lrg-associates.net and we will take the payment over the phone or set up a schedule you can keep. Monday – Friday, 8:00 AM – 4:00 PM PST.