The Ducallier Studios

Secure Cheque / Wire Transfer Order Form


Halifax

This form is used to commission a personal watercolour of your premises by our Works-Master, and the transaction will be deposited and held in a trust account with our financial institution until finalized.

Please make a copy of this page through your browser's "save-as" feature for your records.

Otherwise, if you are transacting a large acquisition or you simply prefer not to use a Credit Card, please use this form.

YOUR E-MAIL ADDRESS MUST BE INCLUDED
IN ORDER TO USE THIS FORM

    Your e-mail address:

     Name:

             Address:

             Town or City:

             State:    

             Country:

             Zip or Postal Code:

             Telephone Number:

This is a Secure Check Order Form

Special Instructions


eCheck Payment Details

This form can only be used with
Cheque or Money Order Wire Transfer payments.

It takes on an average 24 hours to process the your information

This time period could vary depending upon the load on the system.

All fields are required.

Bank Information On Cheque (Please fill out completely)
US Funds Only

             Personal Cheque
             Business Cheque
             Letter of Credit
             Bearer Bond

             Bank Name:  

             Bank’s Address 1:  
                        Address 2:    

             Town/City:  

             State:

             Country:

                ZIP/ Postal Code:  

             Bank Telephone:  

The actual bank code ( ABA ) number is usually on the top right hand corner: and read top numbers first (22-33) with / then bottom numbers (555) as shown in photo.

ABA Number:

Cheque Number:

Routing and account numbers across bottom of cheque.

Separate Groups With (-) from left to right.

Example: 123456789-1234-1234567

Routing Number:

Account Number:

Any special instructions on Check wire transfer:

Shipping / Handling costs will be added on

   Choose Watercolor Size:

By sending this form you are CONSENTING and AGREE that Ducallier Studios use an electronic Bank Draft for the purchase of a commissioned watercolour, painted in the semi-primitive style, by our Works-Master.

Just One more thing !

This is the priority order form, no other method is quicker.

Ducallier Studios

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