AUTHORIZATION TO FAX, EMAIL, AND/OR COMMUNICATE WITH THIRD PARTY

To submit electronically, please complete and submit the below form.

This Consent is signed and agreed to by the following named person. It gives authorization to Receive Revenue Recovery and/or its agents authorization to communicate with me and/or the third party(ies) named below via telephone, mail, fax and/or email as indicated below.

Please complete the following information and submit form below.

You may call our office at 574-247-0862 for the Account #.

AUTHORIZATION TO FAX: By authorizing fax communications, you are consenting to receive electronic communications from RECEIVE RECOVERY and/or its agents to the fax number you have provided...

AUTHORIZATION TO EMAIL: By authorizing email communications, you are consenting to receive electronic communications from RECEIVE RECOVERY and/or its agents to the email address you have provided...

AUTHORIZATION TO COMMUNICATE WITH THIRD PARTY(IES): By authorizing RECEIVE RECOVERY to communicate with third party(ies), you are consenting to RECEIVE RECOVERY and/or its agents communicating, obtaining, sharing, releasing, discussing and otherwise providing to and with each other public and non-public personal information with the third party(ies) named below regarding your debt...

GENERAL TERMS AND CONDITIONS: By signing this Authorization, you consent to us, our clients and agents using any and all information...

WITHDRAWING CONSENT: You may withdraw your consent by sending a written request to Receive Revenue Recovery specifying which authorization you are withdrawing...

THIS IS A COMMUNICATION FROM A DEBT COLLECTOR. THIS IS AN ATTEMPT TO COLLECT A DEBT AND ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE.

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This is an attempt to collect a debt and any information collected will be used for that purpose. By clicking on the ‘Make a Payment’ button you will be redirected to a page where you are able to make a secure payment.
Then have the Make a Payment button that then takes them to the page.

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Your are now leaving the Receive website. These links are provided for your information and convenience only and are not an endorsement by Receive of the content of such linked websites or third parties. Receive has no control over the contents of any linked website and is not responsible for these websites or their content or availability.

Your are now leaving the Receive website. These links are provided for your information and convenience only and are not an endorsement by Receive of the content of such linked websites or third parties. Receive has no control over the contents of any linked website and is not responsible for these websites or their content or availability.

Your are now leaving the Receive website. These links are provided for your information and convenience only and are not an endorsement by Receive of the content of such linked websites or third parties. Receive has no control over the contents of any linked website and is not responsible for these websites or their content or availability.

Your are now leaving the Receive website. These links are provided for your information and convenience only and are not an endorsement by Receive of the content of such linked websites or third parties. Receive has no control over the contents of any linked website and is not responsible for these websites or their content or availability.

Your are now leaving the Receive website. These links are provided for your information and convenience only and are not an endorsement by Receive of the content of such linked websites or third parties. Receive has no control over the contents of any linked website and is not responsible for these websites or their content or availability.

Your are now leaving the Receive website. These links are provided for your information and convenience only and are not an endorsement by Receive of the content of such linked websites or third parties. Receive has no control over the contents of any linked website and is not responsible for these websites or their content or availability.

Your are now leaving the Receive website. These links are provided for your information and convenience only and are not an endorsement by Receive of the content of such linked websites or third parties. Receive has no control over the contents of any linked website and is not responsible for these websites or their content or availability.