• Provide the following information:

  Account # with Northwest Collectors
  Creditor
  Name as it appears on your check
  Street Address
  City, ST  Zip
  Home Telephone
  Daytime Telephone

Pay to the order of:                                     

Date on check:                   

Enter the check amount:  $

Enter the name and address of your bank as they appear on your check:

Bank Name:                                          

Bank Address:                              

Bank Address Cont..               

My check number appears MAKE A SELECTION FROM THIS LIST: ON THE LEFT SIDE OF THE ROUTING # BETWEEN THE ROUTING # AND ACCOUNT # ON THE RIGHT SIDE OF MY ACCOUNT # 

Enter your routing  #, checking account # and check # exactly as they appear on your check:

Routing#: Account#: Check#:

The following are examples of "MICR" lines found on the bottom of the check:

987654321   67895432     00250   <PERSONAL CHECK

BANK ROUTING NUMBER       CHECKING ACCOUNT NUMBER    CHECK NUMBER

 00250   987654321     67895432 <COMPANY  CHECK

CHECK NUMBER       BANK ROUTING NUMBER          CHECKING ACCOUNT NUMBER