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To Submit a Check, please fill out the information below.

A receipt (and confirmation number) will be issued via US Mail the next business day.

The field marked with ( * ) are required fields. (Note: due to costs, check minimum $50.)


-SAMPLE -
webassets/1335475252-check.jpg
- SAMPLE -

BCA "Agency Number"
(or) Client's Name:

First name:

Last name:

 * required
 * required

Address:

 * required

City:

 * required

State:

 * required

Zip Code:

 * required

Telephone:

E-Mail:

Bank Name:

 * required

Routing Number:

 * required

Account Number:

 * required

Your Check Number:

 * required

Amount:

 * required

Additional Notes or Comments:

Print


Don't want to submit online? Click the "printer friendly" button and print the above and mail to :         BCA Financial Services
                        P.O. Box 1037
                        Bloomfield, NJ 07003

or FAX to:    
973-860-1369

BCA will deposit your check the next business day.

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