CheckMAN Order Form

Online Order Form Brought to you by

Click Here For Details on Accepting Checks Online

It's very simple to pay for our products / services online with a check. Simply complete

the form below, and your checking account will be drafted for the amount you authorize.

All orders will be processed by:

The Lewis Financial Group
Harwood Ave.
Baltimore, Md 21212
Ph:(443)540-0225 *If you would rather not order online, you can print this page, and mail to the address above.

Name:

E-Mail:

Company:

Mailing Address:

City, State, Zip: ,

Phone:

Item(s) Ordered / Comments:

Payment Type Online Check

Online CHECK Info (USA only)
Please use the check at the right
to complete the information below.
*The sets of numbers are not always in this order

Name On Check ("A" from above)

Address on Check: ("A" from above)

City / St / Zip on Check: ("A" from above)

Bank Name: ("B" from above)

Bank City & State: ("C" from above)

Check Number: ("D" from above)

A.B.A. Fraction: ("E" from above)

Routing Number (9 Digits): ("F" from above)

Account Number: ("G" from above)

All Numbers From
Bottom of Check:
(see instructions to right)
This is Redundant, but it
will insure accuracy.

Amount of Check:

By submitting this form, you are giving The Lewis Financial Group
permission to draft a check on your checking
account in the amount listed directly above this box.

By submitting this form, you are giving The Lewis Financial Group permission to draft a check on your checking account in the amount listed directly above this box.
Name:
E-Mail:
Company:
Mailing Address:
City, State, Zip:	,
Phone:
Item(s) Ordered / Comments:
Payment Type	Online Check
Online CHECK Info (USA only) *Please use the check at the right* *to complete the information below.*	*The sets of numbers are not always in this order
Name On Check	("A" from above)
Address on Check:	("A" from above)
City / St / Zip on Check:	("A" from above)
Bank Name:	("B" from above)
Bank City & State:	("C" from above)
Check Number:	("D" from above)
A.B.A. Fraction:	("E" from above)
Routing Number (9 Digits):	("F" from above)
Account Number:	("G" from above)
All Numbers From Bottom of Check: (see instructions to right) This is Redundant, but it will insure accuracy.
Amount of Check: