Name:*
Ship To Address:
City:
State:
ZIP Code:
Email:*
Comments:

Instructions
- Have a valid check to fill in the fields
- Record the check info in your checkbook
- You will get a cancelled check from your bank as usual.

Phone:

Check Number:



PAY TO THE ORDER OF
 Deerings Market & Deli

Memo

PAY EXACTLY 

 

 US Dollars 

 

Signature

 

Type your full name here as it
appears on your check

9-Digit Routing Number Account Number (Include spaces and dashes)

These numbers appear on the bottom of your check
 

BY SUBMITTING THIS ORDER, I am authorizing Deerings Market And Deli to draft a check one time on my bank account for the amount indicated. I understand that the check will appear on my monthly
bank statement, and that a $20 returned check fee may be charged if my account has insufficient funds.


 

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