Secure Online Check Order Form

**All Information Listed Below Is Required For Payment Processing**


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Online Check Payment Details


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By initializing, I hereby authorize EZPick3.Com to create a bank draft in the amount of $29.95 and deposit it for this order. I also understand that in the event that this bank draft is returned unpaid, I authorize EZPick3.Com to create and deposit a second bank draft in the amount of $59.90 for the original $29.95 order amount and a $29.95 returned payment fee.

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