E-mail Consent

Please complete the following form:

WRITTEN CONSENT TO RECEIVE COMMUNICATION VIA ELECTRONIC MAIL

*Name

*Address

*City/State/ZIP

*Phone

* Atlantic Account No. (the "Account"):

Nature and Scope of Consent: You are providing consent in writing to receive electronic mail from Atlantic in reference to the Account.
Withdrawal of Consent: You may withdraw your consent at any time. Please contact an Atlantic representative at 1-866-397-4100 to withdraw your consent to receive electronic mail or to update your contact information, including your e-mail address.
Affirmation and Electronic Signature: By entering your e-mail address TWICE and then clicking SUBMIT, you are (1) providing your electronic signature as written consent, (2) verifying you are the above-named consumer, and (3) affirming the following:

  • I am providing my e-mail address to Atlantic voluntarily;
  • my e-mail address is not furnished or owned by my employer; and
  • by providing my e-mail address as my electronic signature, I consent in writing to receive electronic mail correspondence from Atlantic in reference to the Account.

*E-mail Address

*Confirm E-mail Address

*Required fields

This communication is from a debt collector. This is an attempt to collect a debt. Any information obtained will be used for that purpose.
New York City Department of Consumer Affairs License No. 1308695, 2025302