Payment Form

Receivables Control Corporation
(763) 315-9600
Secure Electronic Payment Form

RCC or Vendor Account #

Vendor Name

Your Company Name

Your Email Address Required

Your Phone Number

Your Name

Invoice(s) Being Paid

Company and/or Name:

Address

City, State Zip:

Bank Routing #

Bank Name

Bank Account #

Check #

Transaction Amount

Date on Check

The above information is exactly how it appears on the check. Required

Yes

I'm authorized to submit payment Required

Yes

*Filling out this form authorizes Receivables Control to process transaction. There is a $7.95 charge added per transaction.

There will be no solicitation because of this form.

Any questions please call Receivables Control at 763.315.9600.

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