Speedpayment Form

YESNO Customer Name: You may remit payments on your account(s) online by utilizing our Phone Check service. By entering the required information from your check, we will be able to produce a check for deposit the next business day. Please remember to record this Phone Check in your register and remove that check number from your checkbook. The Phone Check will take its place and will be processed like any other check you write. Please make sure the information is accurate to ensure your account is credited properly. There will be a $10.00 fee per transaction (Diversified Financial and Naeda Financial) or a $20 fee per transaction (First National Equipment Financing) which will be added to your payment automatically. DFS/NFL/FNEF Contract #: Email Address: Name of Bank: Bank's ABA #: (From Check *9 Digits) (Please pick one) Bank's City: Bank's State: Customer's Checking Account #: Exact Names on Check: Address: City: State: Zip Code: Check # (From check): Payee (Pay To): Split Payment: Account/Contract #: Amount to be Paid: + Processing Fee: = TOTAL: