Check Payment Form

*This form must be fully completed prior to submission.

File Number*

  -   example: 0123456789-789.

First Name or Company Name *

 
Middle Initial 

 

Last Name*

Daytime Phone*

Evening Phone*

E-Mail Address   

 Best time to call 

  1. You will need to have your checking account information available.

  2. Upon completion of this form, a replacement draft will be produced and
    deposited to your checking account.  This will occur within 48 hours,
    please be sure to void out the check number that you supply for this purpose.

  3. All transactions may be confirmed.

  4. *Please fill in the check.  If you would like to make a series of
    payments please fill in three checks.

Date*

/ /

Street Address*

City or Town*

   State*

 

Zip*

 

Pay to the order of: Commercial Trade, Inc.

 Check Amount* (in writing)

 

Check Amount* (in numbers) $

 

Bank Name*

 

Please input the numbers from the bottom of your check.

 

         Routing Number*  Account Number*   Check Number*         
                                    

  1. Remember to void the original check number in your checkbook register.

  2. I authorize Commercial Trade, Inc. to process this payment.

  3. All partial payments will be applied toward the balance due.

  4. Acceptance of a partial payment does not constitute an approved payment agreement.

  5. A $25 fee will be assessed for any check returned as drawn on non-sufficient funds.

  6. Verify information on any confirmation page that appears, and print a copy for your records (recommended).

  7. Transactions may be confirmed after clicking "submit."