Referred by: Check Chase Online
Business Information
Business Name:
Federal Tax ID:
digits only
Business Type:
RDI Fee:
  Return Deposit Item Fee charged to the merchant
by the depositing bank for returned checks.
Physical Address:
City:
State:
  Zipcode: 
  Contact Information
Owner Name:
Contact Name:
Phone #:
Fax #:
Email:
Website:
Comments:
 
Check Assist Site ID:
  Bank Account to Receive Collected Funds
Route: Re-Enter Route:
Account: Re-Enter Account:
Acct. Type:
Business Checking    A business account is required to
use the Check Chase Online service.
Sales Agent Name:
  By electronically signing this form, I certify that I have read and understand the service Terms & Conditions.
Full Name: Date Signed:
 

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Email:
Confirmation Code:
   
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