Customer Name: You may remit payments on your account(s) online by utilizing our Phone Check service. By entering the required information from your check, we will be able to produce a check for deposit the next business day. Please remember to record this Phone Check in your register and remove that check number from your checkbook. The Phone Check will take its place and will be processed like any other check you write. Please make sure the information is accurate to ensure your account is credited properly. There will be a $10.00 fee per transaction (Diversified Financial and Irrigation Finance Solutions) or a $20 fee per transaction (First National Equipment Financing) which will be added to your payment automatically.     DFS Contract #: Email Address: Name of Bank: Bank's ABA #: (From Check *9 Digits)   Bank's City: Bank's State: Customer's Checking Account #: Exact Names on Check: Address: City: State: Zip Code: Check # (From check): Payee (Pay To): Split Payment: Account/Contract #: Amount to be Paid: + Processing Fee: = TOTAL:      
John Doe
100 Main Street
Anywhere, US 12345		 Bank Name
Bank Address
City, ST 12345		 No.232

Pay to the Order of: CREDITOR_______________ Amount: $100.00
************** One Hundred and 00/100 ******************* Dollars

MEMO: Account # 1234567890 $100.00

023002908 927000167 000232
(This symbol appears before and after the Routing.) (This symbol appears after the account number.)

 
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