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Please print this page |
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| Name: | ___________________________________________________ |
| E-Mail: | ___________________________________________________ |
| Company: | ___________________________________________________ |
| Mailing Address: | ___________________________________________________ |
| City, State, Zip: | ___________________________________________________ |
| Phone: | ___________________________________________________ |
Item(s) Ordered / TeleMagic DOS Support and / or TeleMagic Software Updates
Please use the check below to complete the information requested.
The sets of numbers (D, F, and G) are not always in this order
Or tape your filled out check below:
| Name on Check ("A" from above) | _________________________________________ |
| Address 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) | _________________________________________ |
| Amount of Check: ("H" from above) | _________________________________________ |
By faxing this form, you are giving Enterprise Automation Group permission
to draft a check on your checking account for the amount listed above.
And remember, the check number you give us is the check draft we will use.
Enterprise Automation Group
54 Glasgow Circle
Hudson, NH 03051-3759
603-881-5619