Fill out your check and copy the information to this form.
Required fields are bold.
A $10.00 ( + S&H )
will be processed and authorization sent to your email address.
If you see 123-45
6789 just use a "/" and enter: 123-45/6789
If you are using a check rather than a bank MICR line specification, just leave this blank. For a bank MICR line specification, enter and x for each place where the account number appears in the MICR line below.
If you are using a bank MICR line specification rather than a check, just leave this blank and enter c for each place where the check number appears in the MICR line below.
, or shift+7
For spaces, just enter
or press the space bar. Be sure to enter the correct number of spaces.
Take a check from your checkbook and fill it out just as you normally would.
Copy the information tagged on this picture from your check to this form.
Click on the "Submit" button below. Your bank account will be drafted for the order amount.
Contact firstname.lastname@example.org with any questions or comments