Pay Your Bill By Check

      Example:
First Name   John
Last Name   Doe
File Number   12345
Phone Number   555-555-5555


check

      Example:  
Routing Number   123456789
Account Number 1212121212
Amount $100.00

* There is a $1 processing fee on all check transactions.
 
I authorize this transfer in the amount shown above with the information I have provided.



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