Auto Debit Form

USA checking accounts only.

Completely fill out the form.
Insufficient information will result in a non-processed order.

Once we receive the completed form and your order has been processed we will send
you an email to confirm your order.

Personal Information: Name: Addres 1: Address 2: City: State: Select Alabama Alaska Arkansas California Colorado Connecticut District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Canada Zip:

ABA or Branch No Looks like: 12-3/440

Check #

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Serious Profits Connection

Bank Name

Bank City aand State

Bank phone number with area code

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Signature:

How to Put Our Affairs in Order-Simplified Book

Bank routing number {9 digits}	Check number	Bank Account number
|: |:		||'

Home phone number

Email address