Complete the application below to switch your billing method to automatic monthly drafting of your checking account.

On the following page, you will be asked to print the application. You will need to attach a voided check, and either mail or fax the completed application to Intrex.

Customer Information
Account Holder Name on Check:
Street Address on Check:
City:     State:     Zip Code:
Telephone Number:
Intrex Username:
Bank Information
Name of Financial Institution:
City:     State:     Zip Code:
Account Number: (As it appears on your check)
Routing Number: (Between         as shown below)
Type of Checking Account:	Personal Business