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First Name:
Last Name:
Phone:
Email:
Account Number:
Total Amount: $
Comments:
OR
Pay By Electronic Check:
ENTER ALL DIGITS FROM LEFT TO RIGHT ALONG BOTTOM OF CHECK
BOX 1 BOX 2 BOX 3
*(Please follow the following instructions when filling out your check information.)
1. BOX 1: Fill in your Nine Digit Routing Number.
2. BOX 2: Fill in your Account Number.
3. BOX 3: Fill in your Check Number.
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