ChecksNet MICR Credit Card Order Form

Phone 725.222.1007 WE MAKE CHECK PRINTING SOFTWARE, PAPER, MICR CARTRIDGES IN U.S.A & SHIP WORLDWIDE This order page is for payment by

VISA, MasterCard or American Express ONLY.
Select item(s), quantity & delivery

Credit card orders incur 5.5% merchant processing & transaction fees.
To eliminate credit card fees, Pay by ChecksNet
Unlisted items are not ready for immediate shipment. Phone or email for availability.

1. Select Product (s)	2. Enter Quantity	Unit Price	Extended Price

		Subtotal:
		3. Select Shipping
		Shipping & INSURANCES*:
		Credit Card Fees:
		Grand Total:

Shipping Notes: Freight rates include fees for dimensional weight, zone, rural, residential delivery, fuel surcharges to addresses in 48 states. Alaska, Hawaii, APO and outside USA will incur additional charges. We email with package tracking number(s), expected delivery date and any changes to shipping cost. Same day shipment and next day delivery not available for international orders. No recipient or 3rd party billing.No recipient or 3rd party billing.
*1: FREE REPLACEMENT INSURANCE included in shipping charge. Report damage within 7 days for fast replacement.
*2:EXTRA INSURANCE COVERAGE included for BAD WEATHER which has resulted in damaged and lost packages.

Bill To:	( Payment Information )	Ship To:
Person Name on credit card: (not business)		Person:
Person placing order:if differentaaaaaaaaa		Company:
Mailing Address for credit card billing:		Street Address:
Address on file with card issuer		We DO NOT ship to P.O. Boxes
Apt/Suite:		Apt/Suite:
City,State,Zip: & country if outside USA		City,State,Zip: & country if outside USA
Day Phone: XXX-XXX-XXXX			Outside USA orders are shipped ONLY to street address on file with credit card issuer
Email address:		< REQUIRED
REFERRED BY: :		< REQUIRED
Select REORDER unless 1st order from ChecksNet
Printer Model(s):		< REQUIRED
Such as Lexmark MS321, Xerox B600

CREDIT CARD: Fill-in VISA, MasterCard or American Express numbers below:

                                                     DO NOT use dashes or spaces
                                                                        Example: 1111222233334444
   Choose:   Card #:   Expires: Month Year

3 or 4 digit Card Verification Number (CVV)
(on back or front of card, (photos below):
VISA / MC 3 digits on back, AMEX is 4 digits on front
Credit Card verification Number

ChecksNet™ protects your information from theft by encoding & scrambling data transmitted from this secure website. We follow Gramm-Leach-Bliley Act for privacy of financial information & comply with ESIGN Act. By submitting this form, you authorize payment to ChecksNet for item(s) & delivery service selected above. You agree to pay ten dollar additional processing fees if any provided credit card information is inaccurate and fifty dollar fee if charge is disputed for any reason. By submitting this order, I agree to guarantee, terms & conditions.
< Checkmark required

If pop-up appears when clicking SEND ORDER,
required data is blank or incorrect. Go Back to correct.

If page flashes or reloads after clicking SEND ORDER button, it's a minor browser problem.
If we receive more than 1 copy of order, don't worry. We don't duplicate identical orders.