Mark and Andrea's
- Online check order form -

-- Billing Information --

Part #A -- Check number:  

Part #B -- Branch Number:

(usually in a format similar to 50-9999/9999)

Part #C -- Your Name and Address: (exactly as it appears on check):

Part #D -- Bank Name and Address: (exactly as it appears on check):

Part #E -- Bank Transit Number:

(Must be a 9 digit number)

Part #F -- Account Number:

-- Mailing Information --

How many would you like to order? :

Name and Mailing address to send your order to:

Your Email Address:

Your Phone No:

(This is in case of any problems. Your phone number will not be given out to anyone.)

Electronic signature. I understand that this is a check transaction, and by clicking this box, I authorize Mark Hutto to draft a check in the amount stated below.

(required)

Total amount to be charged to your account: $2.50 (per Order)

Make sure you make a note of this transaction in your checkbook. Banks will not honor mulitple checks with the same check number, so be sure to void the check you used for this transaction.