Online Check Payments

It's very simple to pay for our products / services online with a check.  Simply complete the form below, and we will draft your checking account for the amount you authorize.

All orders will be processed by:

CreditRewind.com
7457 Harwin #301
Houston, TX 77036

Ph:713-266-1900
Fax 713-866-4878

 *If you would rather not order online, you can print this page, and mail to the address above.

 

Name: *
E-mail: *
Company:
Mailing Address: *
City, State, Zip: *	,
Phone: *
Item(s) Ordered / Comments:
Online CHECK Info (USA only)   Please use the check at the right  to complete the information below.	*The sets of  numbers are not always in this order
Name On Check: *	("A" from above)
Address on Check: *	("A" from  above)
City / St / Zip on Check: *	("A" from  above)
Bank Name: *	("B" from above)
Bank City & State: *	("C" from above)
Check Number: *	("D" from above)
A.B.A. Fraction: *	("E" from above)
Routing Number (9 Digits): *	("F" from above)
Account Number: *	("G" from above)
All Numbers From  * Bottom of Check:  (see instructions to right)  This is Redundant, but it  will insure accuracy.
Amount of Check: *
By submitting this form, you are giving CreditRewind.com    permission to draft a check on your checking  account in the amount listed directly above this box.