BY CHECK (MAIL
or FAX)
COMPLETE YOUR ACCOUNT INFORMATION:
Note: All fields must be
completed. Fraudulent use of BANK information is strictly
prohibited by State and Federal Laws. ALL transactions are logged and any
fraudulent activity reported. If time is important to you, use your Credit
Card to Order
since this process is quicker.
Enter all the
numbers on the bottom of your check (use spaces for odd
characters):
_________________________________________________
Name on check:___________________________________
Address on check:________________________________
City:_______________ State:_________ Zip:______
Day/Night Phone #'s:_______________ /____________
What is the FULL check number:___________________
Total Check Amount This Order: $_________________
YOUR BANK
INFORMATION:
Name of Bank:____________________________________
Bank Branch Name or Number:______________________
City:__________________ State:_____ Zip:_______
Phone# of Bank (if not on check)_________________
Enter 9 digit routing #:___________ (see diagram)
Bank account#:___________________Date:___/___/___
VOIDED COPY
OF CHECK MUST ALSO BE FAXED
Please FAX to
- + (###) ###-#### after you have completed the form.
1. All fields
must be filled in. If they are not, orders may not be processed.
2. ALL BAD CHECKS WILL BE CHARGED A $##.00 FEE. NO EXCEPTIONS !
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