FreeCRM.com

eCheck Payment Form by www.fun2dj.com

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Please complete the information requested below to make your eCheck payment.
(Fields marked with * are required.)

Date *

Name & Address on Check *

Check # *

Transit # (first two digits only) *

Check Amount *

Bank Name *

Bank Address / City / State

Routing # (9 digits) *

Account # *

Memo for your records

Confirmation

OK, one more step. To confirm your order, we will ask you to enter the complete row of numbers at the bottom of your check, your Internet email address and Phone Number 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 *

Email address *

Phone Number *

Press Finish

By choosing "Finish" you authorize our company to draft your bank account for the "Check Amount" entered on this form in return for Live DJ Services. You acknowledge that you are the owner or authorized signer on the account and the information entered in this form. Your order will be processed through your local bank as a normal check and your account will never be accessed electronically. After you have entered the information, there is no need to mail the actual check. Simply write the ordering information in your checkbook for your records just as if you had sent it in.