Services Promotion Non-Secure Order Form
Please contact us immediately if you have
problems using this form.
Line 1:Line 2:
$30 option $55 option
$50 engine presence service $30 with
an option above
Snail Mail (credit card/check
or money order US funds)
Card Type: Visa MasterCard American
Take care in filling out all the
Name (as appears on check):
CHECK PAYMENT INFO: (As it appears on your check!)
Note: If you're confused as to what is what on your check, asks your banker will be happy to help.
Address: Line 2:
NOTE: Get out your check book and use the next available number
Be sure to make an entry for this check in your Check Register
Bank Zip Code:
Bank Routing# (ACH#):
NOTE: The routing # digit# at the bottom of your check on the
MICR Line. Most likely the left-most series of numbers
Branch Fraction: TOP#: BOTTOM#:
[ NOTE: This is the Fraction at top-right of check near the check# ]
Your Checking Account#:
If your account has pre-digits enter your account number as NNN|XXXXXX where NNN are
the predigits ( the number 725 before the customer number in the above example)
and XXXXXX is your account number. Always separate the two with |
Bank Draft Total:
Check this box to Authorize payment for the total amount listed above by bank draft.
Check to authorize check to be made out to "Infopage Services"
These 2 boxes must be checked in order to process your account.