spanishmaster Secure Order Form

Secure Order Form

Select the item(s) below that you would like to order. Your transaction will be confirmed by email.

GENERAL INFORMATION

First Name: Last Name:

Address:

City: State: Zip:

Country:

Phone Number:

E-Mail Address:

CHECKING ACCOUNT INFORMATION

At the bottom of your check is a series of numbers, separated by symbols. It is not necessary to enter symbols or spaces in the fields provided below.

Enter the series of nine numbers
between this symbol

Enter the series of numbers
found before this symbol

Dollar Amount

Check number to use: (Not required.)

Note: Some banks use a non-standard format in this series of numbers. If your account number includes this symbol , simply disregard the symbols and enter this section of numbers.

ELECTRONIC FUNDS TRANSFER AGREEMENT
By submitting this form I authorize you and my financial institution to initiate a debit entry to my bank account appearing on this form. This authorization is for a single entry and may only be resubmitted if the original entry is returned by my financial institution.

Submit this form ONCE ONLY. Your transaction should be completed in 10-60 seconds, depending on Internet traffic. In some cases, it may take longer.

First Name:	Last Name:
Address:
City:	State: Zip:
Country:
Phone Number:
E-Mail Address: