THE BARN YARD
Secure Payment Form
Order Summary
Date
Requested Amount
Note: $250,000 Daily Limit
Contract & Request Number
Salesman/Project Manager
ACH Format
ACH
Pay By Check
Pay By Credit Card
Name as on Check
Bank Routing Number
Bank Account Number
Bank Account Type
Checking
Savings
Billing Information
First Name
Last Name
Address
City
State
Zip
Phone Number
Email Address
