Secure Order Form

[ Order ]

Please fill in ALL fields.

Account Information

Check Number

 Branch Number
Account Name and Address
Bank Name and Address
Transit Number ( 9 digits ) Account Number

Shipping Information

Shipping Address
Daytime Telephone Email Address

Product Information

Item

 Style Quantity Cost Each Amount
1
2
3
4
5
Subtotal
Shipping & Handling
CT Sales Tax*
TOTAL  ( Amount to Draft )

* Any order shipped to a CT address will be charged 6% Connecticut Sales Tax.

Electronic Signature

By checking the box below you give Hanks Place permission to draft your account, listed above, for the amount shown in the TOTAL box. You further agree to pay a $25 service charge for drafts returned by your bank.

This box MUST be checked or your order cannot be processed.

Don't forget to note this transaction in your checkbook register. Banks do not honor multiple checks with the same check number.