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Electronic Checking Account Debit

In order to debit your checking account, we will need information from you about your account. We will need the name of your financial institution, as well as your routing number, account number, and check number. See the sample check below to find this information on your check.

We will also request your driver license number to verify your identity.

Your Name:
Name of Your Financial Institution:
Your Financial Institution's Phone:
Routing Number :
Your Account Number:
 

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