Yes! I want to put my web site on autopilot. Count me in!
I understand I may write to you via email or snail mail and cancel any time.
(When you sign up, we'll set up a stat page for you at
BannerCo-Op.com specifically for this program & send you your passcode and
|How Many Click-Thru Visitors Do You Want Each Month?
|Payment Information - Checking
debit my checking account monthly as indicated by the participation option I have chosen above. I reserve the right
to write you at any time and cancel this option, with 30 days notice.
To use your checking account for payment, please follow
these simple instructions: (U.S. residents only)
- Take a check from your checkbook, fill it in as if you
were going to mail it to us, then record it in your check register.
- Make your check payable to: BannerCo-Op, Inc.
- Copy ALL the information on that check to this form.
NOTE: The information you provided above (name,
address, etc.) must match the information as it appears on your check exactly.
- Write "VOID" on your check and keep it as a
- Your payments will appear on your next and subsequent
Please enter the following required account information
from your check.
Bank Transit Code
By entering and submitting your checking account information,
you make the following statement: "I wish to place an order, and hereby authorize BannerCo-Op, Inc.
to duplicate the enclosed check information in bank draft form. I
understand that the Payee, (BannerCo-Op,
or authorized agent of Payee, will sign the bank draft as my agent for these transactions."
Comments or special instructions