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Company Name

Street Address

City, State and Zip

Phone and/or Fax

Additional Line

Imprint Color

Bank Name

Bank Address

Bank City, State and Zip Code

Fraction Code

Please submit your routing and account number by uploading a voided check, starter check or bank documentation.

Submit your routing and account number by:

Fax your account information in 3 steps:

1. Click link to print fax cover sheet. You must place your order online before sending your fax.

Once you have placed your order:
2. Fill in the Business Name and Item number on the fax cover sheet. The Item ID is a unique number tied to your ordered item (e.g. D-PFTEMP-CDB478F)
3. Fax your cover sheet and MICR Information to 800-503-3429

Click "upload" to submit your voided check or bank documentation.

Select number of signature lines required.

The default signature title is AUTHORIZED SIGNATURE. You are able to change the title below.

Signature Title 1

Signature Title

Do you require text above the signature line?

Please enter the text.