VirtualCheck Payment Information

To complete your Order, please fill in this short VirtualCheck Form. A VirtualCheck is an OnLine Check. Using your existing Checking Account, you provide your Account Info, and authorize us to create a check for the Order Total. You should write out the original check and keep it as a record of the transaction. We'll also mail you a VirtualCheck Customer Confirmation Voucher showing your Transaction details.

Checking Account Info:
Name on Account			Payor's Address
Payor's City			Payor's State
Postal Code			Telephone

Check Number			Check Date
Check Amount			Authorized By

Pay To The Order of : Integrity Internet Consulting

Bank Name			Bank Address
Bank City			Bank State
Bank Postal Code			Bank Phone
Routing Number			Account Number
VirtualCheck Authorization We authorize you to use the above information to generate a VirtualCheck for the Order Total. This authorization is for this transaction only. We understand you will send a VirtualCheck Customer Confirmation Voucher with our Order.