“This is an attempt to collect a debt. Any information obtained will be used for that purpose”
Security Credit Systems, Inc. is a debt collection agency.

Required Indicates a required field

Account Information
REF #.:
First Name: Middle Initial:
Last Name:  
Responsible Party:
Zip Code: (xxxxx-xxxx)
Social Security No.: (xxx-xx-xxxx)
Date Of Birth: (mm/dd/yyyy)
Home Phone: (xxx-xxx-xxxx)
Work Phone: (xxx-xxx-xxxx)
Other Phone: (xxx-xxx-xxxx)
E-Mail Address:
Employer Address::

Credit Card Information
Note: This address must match the address where the credit card statement is mailed. Providing incorrect information will cause the transaction to be declined, however, a temporary "Hold of Funds" may be placed on your credit card for a length determined by the card issuing bank (an average length of 7 days).
Name (As it appears on card):
Billing Address:
Zip Code: (xxxxx-xxxx)
Card Type:
Card No.:
Expires: -

Payment Information
You can arrange up to six payments at one time.  Each payment can be between $10 and $10,000.
Your transaction history will show:
Two payments (1. payment 2. fee) for each payment date selected.
  Date (mm/dd/yyyy) Reversal Payment Fee Total
Your Total Payments Will Be:  
Please: No dollar signs or commas. Only digits and a single decimal point (e.g., 50.00)
Credit Charges cannot exceed 7 months from today.
No-Fee Option: Send a check or money order made payable to your creditor to:
Security Credit Systems, Inc., PO Box 846, Buffalo New York  14240-0846.

I accept the payment and fee that will be charged to my credit card.

You are about to request a payment be made electronically using your credit card. You must agree to the following:
Credit card transactions are processed by Security Credit Systems, Inc., through our payment service. Your credit card statement will show "Security Credit Corp" as the payee. There will be a processing fee of 2.5% for all payments made through this service. This charge is made to offset the charge of the credit card company (Mastercard/Visa) to SCS for processing the payment on your behalf. The approximate charge is calculated and displayed above for your convenience.

  • I authorize a charge to the above specified credit card.
  • Should this transaction fail for any reason (including invalid account numbers, chargeback, etc.) I understand that additional penalties, fees and interest may accrue.
  • By completing and submitting this form, I affirm that:
    1. I have read, understand and agree to be bound to the terms of this agreement.
    2. I am authorized to perform this transaction by the legal party to the debt(s).
    3. I am authorized to perform transactions using the card information provided.

  • By checking this box, I certify, under penalty of law, that the information provided is correct and that I accept the terms of this agreement as presented in the contract.