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Bank Transfer Authorization for Press On Veneers

By completing this form, you understand that you agree to purchase Press On Veneers using Electronic Funds Transfer(EFT).

Confirm Your Information

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First Name:

Last Name:

Bank Information

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Bank Name:

Account Number:

Routing Number:

Are You A U.S. Citizen?

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Driver's License Number:

Issuing State:

Do you agree to use the Bank Information above to purchase Press On Veneers?

By clicking, I agree to purchase Press On Veneers using Electronic Funds Transfer (EFT). I agree that I will be responsible for all payments for Press On Veneers. I confirm that I have read the E-Sign Consent and I agree to have the Terms & Conditions presented electronically. I hereby swear or affirm that all information provided is true and accurate.

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