Check Order Form

Date________________

Name______________________________________________________________

Name______________________________________________________________

Address____________________________________________________________

City_______________________ State_______ Zip Code____________________

Account # _________________________

For questions and account services, please contact us locally at (620) 672-6421, extension 0, or toll free at 1-800-300-3817. Once you have completed the form, please mail to us at the address shown above.

*By ordering your checks using this form, you will not be able to change, add, or delete your personal information, check style, color, etc. Your checks will be identical to your last order.