Please fill out all required information from your check.
If the name on your check is different than the name on the invoice
please put the name on the invoice in the memo box so we can identify the payment..

 

Your name as it appears on your check

Your address as it appears on your check

Your city, state & zip code
,

Company Name

Bank Name

Check number

Bank Id #
---- Example: 63-256 / 4567----------------
/

       Amount $

Email

Memo 
-------Any misc info will go here
Type name of check signer in signature box.
Signature  Phone # ( )

USE THIS SETUP ------ Bank Routing Code and Bank Account Number      

OR USE THIS SETUP ---- Bank Routing Code and Bank Account Number

If you need help filling this form out please call us at 
425 489-0124
and ask for check assistance.