Payee Positive Pay Laser Check Order Form

Payee Positive Pay Laser Checks


1) Quantity or Kit
2) What Color Stock
3) Start Number
4) Check Imprint
Title of Business
(Account Title Or DBA)		Physical address required for delivery. If a PO Box is used here, please add address below in the Alternate Shipping Area.
Address
City,State, Zip
Phone On Check
5) Account Information
Bank Name
Bank City & State
Bank Fraction Number
Bank Routing Number
Bank Account Number
6) Software Name & Version
7) Extra Signature Line		If so, add text to special instructions box.
8) Logo
9) Attach Art File
10) Proof		Proofs add 3 days to Production Time
11) Collation
12) Special Instructions		Use this area for additional instruction. (ex. 2nd signature line info, logo instructions)
13) Contact Information
Contact Name		at business where product will ship
Contact Phone
Contact Email
14) My Representative Is
15) How Would You Like To Pay
16) Credit Card Info
Credit Card #
Credit Card Exp.
Name on Card
17) Promotional Code
18) Production Rush
19) Shipping Method

Click Submit to send your order. A page will follow, which can be printed for your records. Thank you for your order.