Your Name as on Check:

Your Address:

City : State/Prov: ZIP/Postal Code:

Your Phone: no spaces(can be home or work number, you MUST give a number)

Your E-mail:

Be certain to enter a VALID email address to avoid a delay in processing your order.

Bank Name as on your check:

Bank Address as on your check:

Bank City: Bank State:

Bank City: ZIP CODE

In the upper right corner there is a number
that looks like a fraction ___-___ / ____:
place the - and / in the number
Type the 9 digit routing number from the bottom left of your check
(must be 9 digits):

ACCOUNT NUMBER:

Today's Date: CHECK NUMBER:

AMOUNT OF YOUR ORDER:

 

GRAND TOTAL TO DRAFT
Please enter any comments here or special instructions here:
ELECTRONIC SIGNATURE
IMPORTANT! I understand that this is a check transaction, and by clicking this box, I authorize Richard Haycook to draft a check in the amount stated above in the GRAND TOTAL BOX.  I further understand that I will be charged a $20 service charge for a returned check.  IMPORTANT! (This is required or your order can't be processed)
Make sure you make a note of this transaction in your checkbook. Banks will not honor mulitple checks with the same check number, so be sure to void the check you used for this transaction. Your host name and IP address are being captured.  All fraudulent transactions will be investigated and prosecuted.

BY CLICKING THE SUBMIT BUTTON YOU HEREBY AUTHORIZE THE ABOVE CHECK NUMBER TO BE USED AS AN ELECTRONIC CHECK IN THE AMOUNT OF YOUR ORDER
(Please allow 7-10 business days for the bank to process your check)