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Mascon Payment Services
Please complete this form if you are either reporting a payment or requesting a payment arrangement

*Note: For online payment arrangements we can accept a maximum of 2 payments and the minimum payment must be 50% of the outstanding balance. The Mascon Account must be paid up to date within 6 weeks of submission date. For longer term arrangements please contact us at 1-866-832-6020
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Account Holder Name *
Submitter Name *
Account # (Last 6 Digits) *
Phone Number *
Payment Services Request *
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