Online Check Order Form
For Bank Accounts in the Unites States Only
After filling out ALL fields below, press the Submit button to
(Note: all fields on this form must be filled in to process your order)
Phone number.: (Please include area code)
(sorry this form does not add - you will have to change
the figures in the editable fields before you press submit)
(enter information as it appears on one of your bank checks - USA Banks Only)
Bank Phone: (if known - include area code please)
Now using the following lower portion of a personal check as an example,
enter the information that appears at the bottom of your check.
Bank Routing or "Transit" Number:
Your Account Number.............:
Optional - Enter here any special comments or other
information we need to know such as if your ship to address
is different than what is listed above.
OK - 1 more step. To confirm your order,
email address, and the correct numbers, we will ask you to
enter the complete row of numbers at the bottom of your check
and your Internet email address below. your entry here must
be complete, and will act as your signature confirming your
order and intent.
Complete row of numbers at bottom of check:
To verify your email address, enter your Internet email
address again here:
By choosing "Submit" you authorize YOUR
COMPANY draft your bank account for the "Total
Cost" amount shown on this form in return for YOUR
PRODUCT. You acknowledge that you are the owner or
authorized signer on the account information entered in this
form. Your order will be processed through your local bank as
a normal check and your account will never be accessed
electronically. After you have entered the information, there
is no need to send the check to us. Simply write the ordering
information in your checkbook, just as if you had sent it in.
After you press the "Submit" button and receive
the "thank you" message, you may choose the back
button on your web browser to return to previous web pages.