PFA Electronic Check Order Form

By submitting this form you authorize YOU and/or YOUR COMPANY, at ADDRESS, to draft a check on your bank account for the amount shown below if paying by check. You will receive a copy of the check in your next monthly bank statement. By pushing submit you agree to the charges you submit.

 

Please provide the following information as it appears on your check for billing

Name on Check or Card 
Company Name (If Any) 
 
Address  
 
City  State  Zip
 
Phone Number 
 E
mail Address 

Bank Name 
Bank City
Bank State 



 


Check # 

 

 

 

Pay to the order of: PFA - Professional Financial Associates * 

Memo For:  

$

 

 

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*By entering the amount and pressing submit you agree to allow YOUR COMPANY to draft a check for the above amount if paying by check. You also agree to the terms and conditions of your credit card agreement. All returned checks will be subject to a collection fee not to exceed $35 and will vary from state to state. Declined or disputed credit cards are subject to a $49 processing fee. By submitting this order you agree to use the payment method above to pay for the entire order.

 

 

 

 

 

 

 

 

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