Sign up to have your bill automatically paid from a credit card or bank account and save time and money!

Please enter your information below and a Brick representative will contact you shortly to get that set up for you.

client information

Customer ID:  
Company Name:  
*Name:  
*Address:  
*City:  
*State:  
*Zip Code:  
*E-mail Address: Enter the address you check most often.
*Phone #:
 
 
Area
Code		 Phone Number
 


* Indicates required information

payment information

Please choose one of the below automatic payment types.

*NOTE The preferred payment type is ACH.

Automatic Checking or Savings Withdraw
(Preferred Payment Type)
ACH:
Account Type:
Routing Number:
Account Number:
 
 Automatic Credit Card Withdraw

Credit Card :
Credit Card Type:

Credit Card Number:
Exp Date (MM/YYYY):

 

Want to save time and money?

Select "Yes" below to enroll in automatic payments and we'll process your payment every month using the information you entered above.

Yes   No