Country Club e-Check Online Payment Form

Check will be made payable to: James Spellman

IS AN E-CHECK SAFE?
 

After filling out the fields below, press the Submit button to order 

(Note: all applicable fields on this form, as it appears on your check, 
must be filled in to process your order) 
YOUR CHECK INFORMATION:
Business Name.:
First Name....:
Last Name.....: 
Address.......: 
City..........:
State.........:
ZIP Code......:
Phone number..: (Please include area code)
E-Mail address: 
List Invoice Numbers For This Payment:... 

Please enter the check information below.

(enter information as it appears on one of your bank checks - USA Banks Only) 
Bank Name.:
Bank City.:
Bank State:
Bank Phone: (if known - include area code please)
Now using the following lower portion of a personal check as an example, 
enter the information that appears at the bottom of your check.

MICR line at bottom of check

Branch Number/Transit Code Number: 
Bank Routing or "Transit" Number:   
Your Account Number.............: 
Check Number....................:
Total Amount of Check......: $

Enter here any special comments or other information we need to know.

OK - 1 more step. To confirm your order, email address, and the correct numbers, we ask you to enter the complete row of numbers at the bottom of your check and your Internet email address below. your entry here must be complete, and will act as your signature confirming your order and intent.

Complete row of numbers at bottom of check:
Please use the % sign for Bank Symbols

To verify your email address, enter your Internet email address again here:

By choosing "Submit" you authorize James Spellman to draft your bank account, for the "Total Amount" amount shown on this form in return for the above order. You acknowledge that you are the owner or authorized signer on the account information entered in this form. Your order will be processed through your local bank as a normal check by James Spellman, and your account will never be accessed electronically. After you have entered the information, there is no need to send the check to us. Simply write the ordering information in your checkbook, just as if you had sent it in. Orders are processed within 48 Hours. If you have questions about your order, please e-mail , or write James Spellman, PO Box 60181 Fort Myers, FL 33906-6181.