Auto Debit Program

This page is NOT a secure form. Please call Customer Service and we will mail, fax, or email a blank form for you to return. 954-753-0380 option 1

To have your payments automatically debited from your checking account, fill out the form below. We also need a voided check, so after filling out the information below, please write VOID on the check and either mail it to our office, or fax it to (954) 753-8784.

Normally your payments will be drafted on the billing cycle following signup. To know when the debit process will start, look at the "Amount Due" box for the words "AUTO-DRAFT" or "Will be drafted on or before due date".

If you have any questions about our automatic debit program, please feel free to contact us online or by phone at (954) 753-0380.


Are you signing up or cancelling auto-debt?


Please use a blank, voided check for the following information. You will need to mail or fax the check to our office so we can match it to your account.

Please do not use a deposit slip as some banks use a different routing number for checks and deposit slips.

* These fields are required. Contact form template by Bootstrapious.

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead contact this office by phone at (954) 753-0380, or in writing at 10300 NW 11th Manor, Coral Springs FL 33071.