Complete Your Enrollment

You have been approved for a payment plan with the Office of Special Counsel Andy Bowers. Please complete the form below to provide your payment information and finalize your enrollment.

ℹ️ If you have been referred to this page, your payment plan proposal has been reviewed and approved. Submit the form below with the payment details confirmed with your account manager. If you have questions, contact our office before submitting.

Payment Plan Enrollment Form

All fields marked with an asterisk are required. Enter the payment amount and frequency exactly as approved by our office.

First Name *

Last Name *

Email Address *

Account Number *

Found on all correspondence from our office (also referred to as OAG # or Lead Account Number).

Approved Plan Details

Approved Payment Amount *

Enter the exact amount approved by our office.

Approved Frequency *

First Processing Date *

Must be within 30 days of today.

Payment Method

Payment Method *

Card Number *

Expiration Date *

Security Code (CVV) *

Routing Number *

The first 9 digits on the bottom-left of your check.

Bank Account Number *

Your payment information is transmitted securely to our office. We will contact you if additional information is needed.

✓

Enrollment Complete

Your payment plan enrollment has been received. We will contact you if we need any additional information.

Your first payment will be processed on the date you selected.

Questions? Email contact@ohiospecialcounsel.com