Email Authorization Form

If you prefer to speak with someone immediately, please call our toll-free number at 866-765-3310. Office hours are 8am – 5pm Monday – Friday EST. This box is not monitored. If you need to discuss your account in detail, please call our office and speak with a representative. If you have questions please call 866-765-3310.

An Important Note Regarding Collection-Related Inquiries:

If you choose to communicate via email, please remember that no matter how many measures we take to ensure the confidentiality of your email, the Internet may be a non-secure medium for communication. If you choose to communicate your collection-related inquiry via Email/SMS/Texting, we cannot be responsible for any possible disclosure of an account to a third party.

By completing the form below and submitting this information, I consent to communication regarding my inquiry and authorize you to contact me using the contact information I have provided.*
- I Agree
Name*
ACCESS ID #*
Current Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Best phone number to call*
Is the above phone number your cell phone?*
- Yes
- No
Email*
Current employer
Current employer phone number
SMS/Texting OPT IN/OUT
By checking the box “OPT IN”, I agree to receive recurring messages from ACCESS RECEIVABLES MANAGEMENT to the provided mobile number and also agree to ACCESS RECEIVABLES MANAGEMENT’S Terms & Conditions and Privacy Policy. Message and data rates may apply. By checking the “OPT OUT” box, you will be opted out of receiving SMS/Text messages.
OPT in/out*
- OPT In
- OPT Out
How may we help you?*
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If you need to upload a file it must be a JPEG or PDF and less than 6 MB in size
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The laws and regulations related to debt and credit that protect consumers.
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https://www.knowmydebt.com

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