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                     Merchant Sign-Up Form
 

Thank you for your interest in our ChekXcept program and our services. Below is a contact form which we would like you to complete. Once complete, enter the security code shown and click submit. One of our staff will contact directly to set up an appointment.

Business Name:*
Contact Person:*
Email Address:*
Phone Number:*
Phone Extension:
Address Line 1:*
Address Line 2:
City:*    State:*    Zip:*
Approximate Number of Bad Checks Per Month:*
To better protect your information,
please enter the security code shown in the box here.
59890
* Required Information
We will work full time for you to recover your lost revenue.

ChekXcept
RR#2, Box 2159A
Stroudsburg, PA 18360
Phone: (888) 282-2802 · Fax: (570) 422-1025
Member of American Collectors Association
Contact us at: checkbook@verizon.net
ChekXcept is a member of the American Collectors Association