Springfield Payment EP | Tel-A-Rent Inc.

SPRINGFIELD E-Z PAYMENT

PAYMENTS ARE MANUALLY PROCESSED UPON RECEIPT. PAYMENT INFORMATION WILL BE RECEIVED IMMEDIATELY AND CREDIT WILL BE APPLIED TO ACCOUNT UPON APPROVAL OF CREDIT CARD. TRANSACTION MAY TAKE 24 HOURS TO PROCESS. THANK YOU!

First name on account

Last name on account

Phone

LAST 4 DIGITS OF CARD

AMOUNT TO PAY

Special Instructions/Comments

I hereby authorize Tel-A-Rent Inc., central office located in Springfield Missouri) to initiate a charge from my credit/debit card. I agree that I am fully authorized to use and initiate this transaction on the card provided. I understand that if this is a debit card the charge may be debited from my institutions ATM/ACH network. In the event that a credit entry is made in error, I will provide Tel-A-Rent Inc. with proof of the error so that it may be reviewed and corrected. Further, I agree to not hold Tel-A-Rent Inc., Springfield, Missouri responsible for any delays, or loss of funds due to incorrect or incomplete information supplied by me or my financial institution or due to an error on the part of my financial institution in depositing funds to my account. I agree not to hold Tel-A-Rent Inc. liable for loss of data. I am aware that an online processing fee will be charged along with the principal payment. The online payment credit card fee schedule is as follows: ($0-50 = $1 fee) ($100+ = 3.75% fee). I understand that by providing my electronic signature, I UNDERSTAND AND AGREE to the statements and fee schedule aforementioned. *

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Since 1956!

SPRINGFIELD E-Z PAYMENT

Tel-A-Rent Inc.

Corporate Offices

SPRINGFIELD, MO

REPUBLIC, MO

Manager: Ryan Pierce

OZARK, MO

Manager: Jak Gilmore

SPRINGFIELD, MO

SERVING MARSHFIELD AREA

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