Order Form

Simply order online by using the information from your personal or business check. If you want to fax in your order, you can do so by faxing your check with the information below to (502) 765-4894. Simply print out this page and fax it along with a copy of your check. After your payment information is received, a one-time bank draft (check) will be created for the amount authorized by you in this order. Make sure to enter this check number, payee, and amount in your check register. PLEASE DO NOT USE THE SAME CHECK NUMBER TWICE.

Product Information

Item # Qty. Description Color/Size Price Total
Shipping: $
Grand Total: $

Your Information
Name
Street Address
Address (cont.)
City
State
Zip code
Phone
FAX
E-mail
How did you find us?

Your Bank's Information
Bank Name
Bank address
Address (cont.)
City
State
Zip code
Phone

Your Check's Information

example check

Check Number
Routing Number
Account Number
Branch Number

Authorization Section
Terms and Conditions
By checking this box I understand that due to any returned Check(s) "Drafts" because of NSF, Stop Payment (fraud), false information or any other acts deemed intentional by the customer, I, the said customer, may be assessed an additional $20.00 fee per incident. By authorizing this order, customer agrees that Irving Enterprises can generate an electronic draft "check" for fee(s) that may be due without further notice.

Electronic Signature
By checking this box I understand that this is a check transaction, and I hereby authorize Irving Enterprises to issue a check draft in the amount stated above. Checks will be made payable to Irving Enterprises.