Pay using an e-check from your bank account

By completing the information below you are authorizing Verliance Inc. to process your payment as an e-check.

Please complete all information on the form as it currently appears on your pre-printed check. Include your exact name or the name of your business as it appears on your check, along with the transit number (or routing number), the account number and the check number. Once you have entered the correct information in the appropriate location, fill in the remaining payment information as you would on any check, including the date, the payee, and the amount of the check.

Once the information is completed, press the “Submit” button, and the draft will be created and then submitted for payment. A confirmation will be sent to your e-mail address as verification that the transaction has been completed.

If there are any questions or problems regarding the use of this form, please feel free to contact us at (951) 693-3318, or toll-free at (877) 643-4549.

Thank you for your payment.

  • Your Information

  • Please complete all information on the form as it currently appears on your pre-printed check.
  • Include your email to receive a notification of payment

  • Bank Account Information

  • Type all numbers exactly as they appear on the bottom of your check

  • Other Information

  • Enter dates and amounts for any future payments.

This is an attempt to collect a debt. Any information obtained will be used for that purpose.