Consumer Technology Solutions eCheck Payment Processing Form

*This page is hosted on the CTS Server.

*If paying with a Corporate Check please enter the Company name, as well as the First and Last Name of the account holder.

Company Name:

First Name:

Last Name:

Address as it appears on the check:

City:

State:

Zip:

Phone Number:

Email for Receipt:

Amount You Intend to Pay:

Bank Name:

Routing Number:

Routing Number Confirmation:

Account Number:

Account Number Confirmation:

Preferred Check Number (if Blank, CTS will issue random Check Number, usually the date):

Memo Field:

Invoice # or Quote ID (if applicable):

By clicking submit, you authorize CONSUMER TECHNOLOGY SOLUTIONS to initiate an ACH draft or Pre-Printed Check Draft against the Account Information Provided above. You release CONSUMER TECHNOLOGY SOLUTIONS from any and all liability related to this payment. You agree to any payment terms you checked above.

You understand and acknolwedge that once submitted, the payment may not be altered or deleted.