Your Name:              Your Address: 

Your City:         State:         Your Zip Code: 

Phone #      ( Give us your Main Day-Time Phone # so we can call you if we have questions concerning this order) 

Bank Routing # (always 9-digits)TT Account # (Ignore spaces or dashes) O

Check # OO               Date:    ( mm / dd / yyyy )

Check Amount:      (Do not put the $ dollar sign in the box)

Check Memo:  ( Limited to 100 characters )

(Make note in the above memo area what your payment is for so it will get printed on the check and you'll have a record of what the payment was for.)

Bank Fraction  i.e.  90-8086 / 3222  (This can be found in the upper right-hand corner of your check, near the check #)

Bank Upper Fraction:  i.e. 90-8086   Lower Fraction: i.e.  3222

Vendor Name: Make the Check is Payable to: ICPP

Your Bank Name: