Merchant Information

Submit Checks For Collection

In the News

Before ProCheck can collect on any returned checks, we need to collect a little information about your store(s).

Please fill in all of the following information. *

* Notice: You will be held responsible for any false information submitted. See legal disclaimer for more information.

	Merchant Info:
	Company Name:
	Address:

	City, State & Zip:
	Phone:
	Fax:
	E-Mail:
	Contact Name:

	Number of Stores:

	Are you interested in submitting checks for collection over the internet?	Yes No