Yes. Please click here to download a copy of the form. Please print this out, complete it and mail it into us at the address on the form. Do not mail this form to the Phoenix P.O. Box, as that is for payments only. Please don’t fax or email this form. It will contain your sensitive bank data once complete, and these are not secure submission methods.

Please note the form is designed to accommodate automatic payments for both credit cards and bank accounts. You do not need to fill out sections that aren’t relevant to your payment method. It is recommended that you use a bank account’s routing and account number, as there is no additional fee for this payment method. If you are at all unsure which information is being requested, please simply send a voided check in with the form.