CHECKER® SOFTWARE WEBCHECK ORDER FORM

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 Checker Software Web Check Order Form

(for Online Payment using Personal or Business Check)

Please note, your check must be verified by your bank and cleared before your order will be delivered or shipped. For immediate shipment and access to our download area, Click Here to purchase with a credit card or Click Here to order with your secure PayPal account.

(Fields marked with * are required)
Select Desired Product: *
Safety Check Paper Desired:
Company Name: (optional)
Your Name: *
Email Address: *
Street Address (ship to):
Suite/Apt/Street Address 2 (optional)
City & State: **
Zip Code: *
Area Code & Phone: () - *
Fax Area Code & Phone: () - (optional)
 

Write Your WebCheck Here: (enter information from your check)
Account Holder's Name: *
Amount of Check: *
Check Number: *
Bank Name: *
Bank Street Address: *
Bank City & State: , *
Bank Zip Code: *
Bank Area Code & Phone: () - *
Fractional ABA Number: *(looks like 91-210/1225)
Bank Routing Number: *(9 numeric digits ONLY)
(All funds are US Dollars Only. Canadians MUST put a hyphen in the 6th position)
Your Account Number: *
Check Authorization Agreement:

I choose to purchase your product(s) by check and I have filled in all of the check information fields above. I authorize you to draft my bank account electronically for the face amount of this check, and use Checker software to print a check on my bank for the above selected items in the amounts shown. I understand that when I submit this form, my Internet protocol (IP) address will considered my authorization signature on this check. I understand that the check will show up just like any other check on my monthly bank statement.

I understand that in the event my check is returned unpaid, I will not receive my product(s) and I authorize you to appropriate a returned check fee in the amount of $25.
* I accept this agreement (Your order will NOT be processed UNLESS this box is CHECKED)

Your Comments (optional):
(Please make sure the form is complete and accurate prior to submission)

To order by FAX, DO NOT SUBMIT THIS FORM. Simply complete this form without submitting it, PRINT and FAX this form along with a copy of your completed and signed business or personal check to: +1 (717) 326-5653.

To purchase by regular MAIL ORDER, DO NOT SUBMIT THIS FORM.  Simply complete the form, print it out and mail your form along with your check or money order payable to:
A.I. Micro Order Dept.
725 N Royal Crest Cir. Suite 251
Las Vegas, NV 89169

Your complete order will be shipped immediately upon check clearance (no more than 5 business days in most cases).

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