Make Money Selling on eBay

Bill To:			Ship To:
Name:			Name:
Company:			Company:
Address:			Address:
Apt/Suite:			Apt/Suite:
City,State,Zip:			City,State,Zip:
Day Phone:
Evening Phone:
Email address:			< REQUIRED

Pay with any checking or savings account from USA or Canadian bank (we create bank draft) NOTE: We phone banks to verify funds & account information for your protection & ours. Your submission of this form constitutes your acknowledgement and acceptance of this.
REQUIRED FIELDS *

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     *
     Pay to the
     Order of                Chris Lewis                                               $
     _______________________________________________________________ Dollars

     For ______________________            This draft pre-authorized by accountholder

use letter "D" in place of

use letter "A" in place of

ChecksNet protects your personal and bank account information from theft or misuse by encoding and scrambling the data as it is transmitted from this website to us. By submitting this form, you hereby authorize Chris Lewis to create a bank draft for the item(s) selected above. You further agree to pay a $25 (twenty-five) dollar service charge if bank draft is returned unpaid by your bank.