Customer Name                                     Customer Bank
CUSTOMER ADDRESS                                   Bank Address    11111/1111-111                           1111
                                                                         DATE                   8/06/2012
PAY
TO THE
ORDER OF   YOU OR YOUR BUSINESS NAME HERE                                                        0.00*
ENTER AMOUNT HERE and 00/100*****                                                          Dollars
                                                                                Authorized Check Draft
FOR    MEMO GOES HERE
                                                                                No Signature Required
                          1111              123456789       1111222333