Internet Payment Agreement
Case Number
Current Balance as of Today
Payment Date
Payment Amount
Please note: KDOR is not able to initiate an EFT/Electronic Check debit to a foreign bank account through this portal. Please call Collections at (785) 296-6121 for further assistance.
Bank Account Type
Checking
Savings
Bank Name
Bank Routing Number
Re-enter Bank Routing Number
Bank Account Number
Re-enter Bank Account Number
Name of the Account Owner
SSN/FEIN of the Account Owner
Phone Number of the Account Owner
* Required Field.
Fields only viewable in a test environment when production mode is false.
Penalty Eligible Amount
Net Balance
Projected Penalty
Projected Interest
Projected Fee
Sum (Total of Payments)
Principal
Total Interest
Total Penalty
Other
Balance
