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**Disclaimer: All submitted checks are sent through our system and then printed within our office. Once printed, checks are taken to the bank for deposits.
Processing on these checks may take up to 3-4 business days.**
***Check by Fax,Email and Text always welcome.
Date
Invoice#
Side Mark
Total Order
Balance Due
Payment
Visa/Master Fee
AMX Fee
Paypal Fee
SUM:
Credit Card Processing
Saved Card(s)
New Card
*
*
Expiration Date:
01
02
03
04
05
06
07
08
09
10
11
12
/
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
*
CVV2:
Billing Information
*
First Name:
*
Last Name:
Address:
City:
Zip:
Save
Card number
and
Billing Address
for future use
Yes
No
Saved Check Account(s)
New Check Account
Check Date:
*
Check#:
Memo:
Payor Information
*
Name:
*
City :
*
State :
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
*
Zip :
*
Address :
Account Information
*
Bank Name:
*
Routing# :
*
Account# :
*
Branch# :