Monday-Friday 8am-4:30pm PST
Proof of Payment
About your payment
(Required)
I made this payment
My insurance paid
Another party paid
I was granted Financial Assistance
Which of the following best describes your situation:
(Required)
I want to report a partial payment
I want to report a full payment
Partial Payment: Please choose the date you made this payment below:
(Required)
MM slash DD slash YYYY
Partial Payment: What amount was paid?
(Required)
Describe your proof of payment
(Required)
Please describe what you are attaching as proof of payment (Copy of the front and back of a cleared check / Receipt / EOB / Bank Statement / Confirmation of Payment / Financial Assistance Letter )
Partial Payment: Source of Payment
(Required)
What you attach should match the description you added above.
Drop files here or
Select files
Accepted file types: pdf, jpg, jpeg, gif, png, Max. file size: 20 MB, Max. files: 4.
Full Payment: Please choose the date you made this payment below:
(Required)
MM slash DD slash YYYY
Full Payment: What amount was paid?
(Required)
Describe your proof of payment
(Required)
Please describe what you are attaching as proof of payment (Copy of the front and back of a cleared check / Receipt / EOB / Bank Statement / Confirmation of Payment / Financial Assistance Letter )
Full Payment: Source of Payment
(Required)
What you attach should match the description you added above.
Drop files here or
Select files
Accepted file types: pdf, jpg, jpeg, gif, png, Max. file size: 20 MB, Max. files: 4.
ARG Account number or reference number (if known):
Please enter your full name
(Required)
First
Middle Initial
Last
Email
(Required)
Enter Email
Confirm Email
Phone
Type of phone:
Home
Work
Cell
Other
Additional Phone Number
Type of phone:
Home
Work
Cell
Other
Is this bill for yourself?
(Required)
Yes
No
If no, are you a...
(Required)
Spouse
Legal Guardian
Legal Representative
Other
Describe "Other":
(Required)
Please enter your name
(Required)
First
Middle Initial
Last
Billing Address:
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Enter additional address (if any):
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
You may include any other details that could be important to this payment here.
By clicking "Submit," I acknowledge that Asset Recovery Group, Inc. (a collection agency) may use the information obtained here for the purpose of collecting a debt and that Asset Recovery Group, Inc. may contact me via email.
What is 4 + 6?
Prove you are a human....
Comments
This field is for validation purposes and should be left unchanged.
Skip to content
Open toolbar
Accessibility Tools
Accessibility Tools
Increase Text
Increase Text
Decrease Text
Decrease Text
Grayscale
Grayscale
High Contrast
High Contrast
Negative Contrast
Negative Contrast
Light Background
Light Background
Links Underline
Links Underline
Readable Font
Readable Font
Reset
Reset