Check info form

Cabins-r.us - Rental Payment by Check

Only use this form if your stay is at least 3 weeks away

Please enter all information as it APPEARS ON YOUR CHECK
use <tab> to move to next field - <Enter> will submit form

Cabin Name:

Business Name:

Name as on Check:

First Name:

Last Name:

Address:

City:

State: ZIP Code:

Phone number:

Email address:

Bank Name:

Bank City:

Bank State:

Bank Phone ( incl. area code ):

Now using the following lower portion of a personal check as an example, enter the information
that appears at the bottom of your check. Include dashes or spaces where applicable. DO NOT
try to enter the symbols.

Bank Routing Number:   Your Account Number: 

Check Number:  Use the next available number from your check book.
Mark this check 'VOID' and be sure to make an entry for this check in your Check Register.
Amount:  Please enter:
1) The full rental fee including tax if arrival is less than 30 days away
AND for June, July, August, October and Holiday Weeks (New Year's Day -
Valentine's Day - Memorial Day - July 4th - Labor Day - Thanksgiving - Christmas)  OR
2)  1/2 the rental fee including tax for the other dates

We recommend that you purchase Trip Insurance to cover a potential financial loss.
Visit InsureMyTrip.com for details.

Optional - Enter here any special comments or other information we need
to know.

OK - 1 more step. To confirm your order, email address, and the correct numbers, we will ask you to enter the complete row of numbers at the bottom of your check and your Internet email address below. your entry here must be complete, and will act as your signature confirming your order and intent.

Complete row of numbers at bottom of check:

To verify your email address, enter your Internet email address again here:

Your order will be processed through your local bank as a normal check and your account will never be accessed electronically.

After you have entered the information, there is no need to send the check to us. Simply write the information in your checkbook, just as if you had sent it in and void the check number to avoid duplication.

We will email you further information shortly after receipt of your payment.

Many thanks for choosing our cabin and we wish you 'A Wonderful and Relaxing Mountain Vacation'

By clicking the "Submit" button below, you authorize the information provided to be used for creation of an electronic funds transfer (EFT) or bank draft, and you authorize a debit for the 'Amount' entered on this form from your checking account. The debit may take place immediately, so funds must be readily available.
You agree that if the EFT or bank draft is returned unpaid, you will pay the bank fees, which may be debited from your account using an EFT or bank draft.

You also acknowledge that you are the owner or
authorized signer for the account entered in this form.
The checking account must be at a financial institution in the United States,
and the check must be payable in U.S. dollars.

Ready to send the form?

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