Personal Check form PAGE TWO

"911 Internet Check"

Please fill out your account number, dollar amount of your order & submit....

When we receive your two e-mail messages, [both parts of the "911 Internet Check"]

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We send you a conformation of this transaction TWICE, one e-mail message back to you, and snail mail conformation of the check authorization.

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We will find your Order Form [e-mail] and mark it PAID. Remember to send your Order via E-mail.

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Your order will be sent & processed without the delay of sending us your personal check snail mail!!

 

 

Your E-MAIL Address [again] Please

Your CHECKING ACCOUNT Number

TOTAL DOLLARS FOR THIS BANK DRAFT [Check] $$ Amount

Total $

Written Amount $

READ THE FOLLOWING BEFORE SUBMIT

This box indicates that you wish to place an order, per the attached Order Form [order form submitted via E-Mail or under seperate snail mail direct to our office]. You hereby authorize payment for the Total Amount Due, as shown on the Order Form and just above, "TOTAL DOLLARS FOR THIS BANK DRAFT [Check] $$ Amount" You will retain your original information for your records of this transaction [print this page if needed] This authorization is for this transaction only, no other bank drafts can be created without your direct authorization as precribed by law.

YOUR CONFORMATION OF THIS ORDER AND THE AMOUNT OF THIS BANK DRAFT [Check] WILL BE E-MAILED DIRECTLY TO YOU. A additional "Copy" of this transaction will be mailed direct to your home. Unless cancelled by phone 510.472.0778, your personal check "bank draft" will be deposited and your order processed and shipped. The CHECKED BOX IN THIS SECTION IS YOUR O.K.

My Order has been sent via

I AM READY TO SUBMIT PART TWO

 

JUMP BACK TO PART ONE