There is no fee associated with this check draft authorization. However, there is a service fee added to all returned items of $25.00 or the maximum allowed by law. |
Customer Information |
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Your Name (Authorized User)* |
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Name as imprinted on check* |
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Customer Number
(Debtor Id Number on Notice) |
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Home Phone* |
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Work Phone* |
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Bank Information |
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Bank Routing Number*
(9 digit number on bottom of check) |
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Bank Account Number* |
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Bank Name |
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Bank City, State |
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Check Number To Use |
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Amount Authorized |
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Date We Can Issue |
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