Bill Payment Form
for payments made using a check
This form is for payments made
using a checking account. If you're looking for our credit card payment form,
please click here.
There is no service fee to
pay by check online or by phone. If you have any questions about how to fill out this
form, please call our Billing Department during normal office hours at 1-888-509-8644 or
509-522-3696. You may also email Billing at email@example.com
Please note that online
and phone check payments must be drawn on U.S. banks.
Please provide the
following contact information:
All fields are required unless noted otherwise
First and last name
(as shown on your last bill, not your account username)
Day phone number
Dollar Amount you
wish to pay (in U.S. Funds). Please include the decimal point.
Please provide the following checking account information:
Please be sure
to provide us accurate payment information. There is a $3.00 service fee for any e-check
returned because of invalid account or routing numbers or because the checking account has
holder's day time phone number
Check number being
used for this payment
(9 digit # along bottom of the check)
(usually all other consecutive #s after the routing #. Please include any
(usually found under the check #, looks like 19-2/1245)
Bank Name and Address
(as shown on the check)
Are you submitting
this checking information to update the information used for automatic debit?
(Do you want your checking account to be automatically debited at the start of your
next billing period for the next billing period's hosting fees?)
Additional instructions? optional
Need to update your phone number, email address or mailing address? Renewing your account?
Let us know here.
By clicking submit below, you agree to our terms and
conditions and authorize us to charge the above checking account the amount stated
above. If you answered "yes" to "Automatic Checking Account Debit,"
every hosting period thereafter (monthly, quarterly, semi-annually, or
annually), the above checking account will be debited the appropriate fee unless
you make other arrangements or request your web hosting account to be cancelled at least 5
days prior to the anniversary date of your hosting period. You may cancel your account at
any time by filling out our online cancellation form or faxing it to 509-525-5781. Cancellations
requested in any other way will not be processed. Cancellations are processed the same day
they are received, unless it is noted on the cancellation request to cancel at a later
date, i.e. the end of the paid term.
To help prevent fraud, your IP
Address and Hostname are logged when you submit this payment.
Did you double check your
you for your business!