Info MAX Pro Business Edition
 
ORDERING INFORMATION - when paying by check
Complete, print, and then fill in appropriate sections.
Mail or Fax us your check or credit card order. Mail your check and order form to EBA, PO Box 711, Vienna, Illinois 62995
Purchaser Information:
Name:
Company:
Email:
Phone:
Fax:
Address:
City:
State/Prov:
Zip/Postal:
Country:

Send Your Order To:

Your Name
Your Street Address
Your City, State, Zip
Your Phone and Fax Number

 
By Check (Mail or Fax)

Note: All fields must be completed. Fraudulent use of BANK information is strictly prohibited by State and Federal Laws. ALL transactions are logged and any fraudulent activity reported. If time is important to you, use your Credit Card to Order since this process is quicker.

Enter all the numbers on the bottom of your check (use spaces for odd characters):
 

Name on check:__________________________________________

Address on check:________________________________________

City:____________________  State:__________  Zip:___________

Day/Night Phone #'s:___________________ /__________________

What is the FULL check number:_____________________________

Total Check Amount This Order: $____________________________
Your Bank Information
Your Check Information 
Name of Bank:____________________________________________

Bank Branch Name or Number:______________________________

City:____________________  State:__________  Zip:____________

Phone# of Bank (if not on check)_____________________________

Enter 9 digit routing #:__________________________ (see diagram)

Bank account#:_________________________ Date:____/____/____

 
To order with Pay Pal for Info Max Pro and other EBA-Graphics products and services.
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