* Indicates a required field.
*Name (as appears on check):
*Steet Address (as on check):
*City (as on check):
*State (as on check):
*Zip Code (as on check):
*Phone Number (as on check):
*Bank Name:
*Bank City:
*Bank State:
Bank Phone:
*Transit Code:
*Check Number:
*9 Digit Bank Routing Number:
*Your Account Number:
*All numbers on bottom of check (redundant, we know)
*Your Payment Amount:
Your Fax:
*Your Email:
Please tell us the products and or services you have ordered. (i.e. 2 handbooks) Check box if you already sent a chart services order form with this info
By pressing the "Submit Check" you agree to have a check drafted  for the above amount. $20 Fee for checks returned by your bank for any reason. You may also FAX your check to : 520 744-6923 Simply write a check, tape it to a piece of paper, then fax it, It's that easy! Be sure to include your phone number, sometimes the faxes are difficult to read. Or you may mail this order to JCA UNLIMITED PO Box 91498 Tucson, Arizona 85752 Thanks for Your Order!