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Secure Online Check Order Form

For Bank Accounts in the Unites States Only
After filling out ALL fields below, press the Submit button to order

NOTE: We do not sell, share, trade or in any other way make your name, email address, or other information available to any other party. This information will be treated as strictly confidential and is only used to process your order.


                 (Note: All fields on this form must be filled
      with accurate information as it appears on your check book,
                   in to process your order efficiently.) 
Business Name.:(Legal DBA only)
First Name....:
Last Name.....: 
Address.......: 
City..........:
State.........:
ZIP Code......:
Phone number..: (Please include area code) 
EMail address.:
(enter information as it appears on one of your bank checks
                                            - USA Banks Only) 
Bank Name.:
Bank City.:
Bank State:
Bank Phone: (include area code please)

Now using the following lower portion of a personal check as an example, 
enter the information that appears at the bottom of your check.

MICR line at bottom of check
Bank Routing or "Transit" Number: Your Account Number.............: Check Number....................:

Optional - Enter here any special comments or other information we need to know such as if your ship to address is different than what is listed above.

OK - 1 more step. To confirm your order, checking account name, email address and the correct numbers, we will ask you to enter the complete row of numbers at the bottom of your check, your Internet email address and the exact name on your check book, below . your entry here must be complete, and will act as your signature confirming your order and intent.

Complete row of numbers at bottom of check:

To verify your email address, enter your Internet email address again here:


Verify your account with the actual full name on your check book here:

By choosing "Purchase" you authorize Tattoo Cycles™ to draft your bank account for the "Total Cost" amount shown.

Total: $ 0.00

You acknowledge that you are the owner or authorized signer on the account information entered in this form. Your order will be processed through your local bank as a normal check and your account will never be accessed electronically. After you have entered the information, there is no need to send the check to us. Simply write the ordering information in your checkbook register and void the check, just as if you had sent it in.