Online Check Authorization Form

Complete the form below to authorize your payment(s).

Consumer Information

Central Professional Services Account Number
Account Number
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Field is required!
First Name:
Your First Name
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Field is required!
Last Name:
Your Last Name
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Field is required!
Date of Birth
Date of Birth
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Field is required!
Phone Number or Email Address:
Phone Number or Email Address
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Field is required!
Address
Address 1
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Field is required!
Address 2
Address 2
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Field is required!
City
City
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Field is required!
State
State
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Field is required!
Zip Code
Zip Code
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Field is required!

Banking Information

Bank Name:
Bank Name
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Field is required!
Bank Routing Number:
Bank Routing Number
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Field is required!
Bank Account Number
Bank Account Number
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Field is required!

Payment Details

Payment Amount:
Payment Amount
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Field is required!
Payment Date
Payment Date
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Field is required!

Recurring Payment Options

Would you like to set up recurring payments?
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Field is required!
If yes, please complete the following:
Frequency:
  • Weekly, Bi-Weekly, or Monthly
  • Weekly
  • Bi-Weekly
  • Monthly
Weekly, Bi-Weekly, or Monthly
Field is required!
Field is required!
Weekly (Please select day)
  • Weekly
  • Sunday
  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
Weekly
Field is required!
Field is required!
Recurring Payment Amount
Recurring Payment Amount
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Field is required!
Bi-Weekly (Select One)
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Field is required!
Bi-Weekly Payment Days
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Field is required!
First Payment Date
Select a date
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Field is required!
Monthly
Please specify date of the month for payment (1st - 31st)
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Field is required!

Authorization

By submitting this form, I authorize Central Professional Services to process my payments as described above. I understand that this authorization will remain in effect until I cancel or update my payment details.
To sign use your mouse or if on a mobile device sign with your finger.
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Field is required!
Today\\\'s Date
Select a date
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Submit

Contact Us

Central Professional Services

801 Sunnyside Drive

Cadillac, MI 49601


Phone:

231-775-3711

1-800-748-0031

Business Hours

8:00am – 6:00pm Monday-Friday

8:00am – 12:00pm Saturday


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