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PAYMENT SYSTEMS E-CHECK
Enter the information and numbers from your check in the check below.
ALL INFORMATION IS REQUIRED!

PLEASE USE THE "TAB" KEY TO MOVE THREW THE CHECK FIELDS

Click here for Directions

Your name as it appears on your check

Your address as it appears on your check

Your city, state & zip code
,
Your phone number
Your Bank Name


Your Bank Address
Date

 Check number
           
Pay To The
Order Of: 		PAYMENT SYSTEMS
Amount
     US Dollars
   Type your full name here
Memo  Signature 
Bank Routing Code and Bank Account Number
    
This transaction is secured using the latest in encryption technology

ELECTRONIC SIGNATURE
I understand, by entering "I Agree" below
I irrevokably authorize a bank draft to be made of the above information as this represents my eletronic signature.  


Type:"I Agree" to Authorize payment.
E-mail address:

NOTES: (please be brief but thorough):

   

Attention Check Writer:
PAYMENT SYSTEMS accepts payment under these conditions.
There will be a $25 fee or the maximum amount permitted by law for returned checks.
Check writer is also responsible for all other costs of collection.
Your usage of PAYMENT SYSTEMS E-CHECK for payment is your acceptance of this agreement and its terms.
design by: SomeGuyWebDesign.com   domain name and hosting by: FreeWebPlanet.com