Check box indicating the person making the payment is the same as the person applying for the certificate (Applicant)

Check box indicating the person making the payment is the same as the person the order is being shipped to

Check box indicating the total amount due will be paid in multiple or partial payments

Payment Amount field to enter the amount of the partial payment

Check box indicating the caller has been informed of the Disclaimer

Confirmation of the checking account routing number used for payment

Account Number of the checking account used for payment

Confirmation of the Account Number of the checking account used for payment

Check Number of the check used for payment

Check Number of the check used for payment

Name of the business listed on the check

Phone Number of the business listed on the check

Address Type of the business making payment on the order (business checking account)

Zip Code of the business making the payment on the order (business checking account)

Street Address of the business making payment on the order (business checking account)

Additional Street Address line of the business making payment on the order (business checking account)

City of the business making the payment on the order (business checking account)

State of the business making the payment on the order (business checking account)

Country of the business making the payment on the order (business checking account)

10-digit Phone number of the business making the payment (business checking account) with 4 digit extension field