Red Tray Network

Your checking account may be debited within 24 hours. Do not use this payment option if the funds are not immediately available in your checking account. Checks returned with non-sufficient funds will be automatically assessed a $35 NSF fee.

Payments submitted after the 20th of each month are subject to loss of discount.

Enter the required banking information to be sent to Red Tray in the form below or call Member Services at 800.416.7676.

Statement Amount Due
i-drafts Amount	(US dollars only)
Bank Name
Bank Routing & Transit #	(no dashes)
Checking Account #	(no dashes)
Account Name
City
State
Zip Code

Red Tray i-drafts Terms and Conditions

Payment From Your Checking Account will create an electronic funds transfer
(EFT) or bank draft which will be presented to your bank or financial institution for
payment. The checking account must be at a financial institution in the United
States, and the check must be payable in US dollars.

By clicking the 'Submit Payment Information' box below, you authorize the
information provided above to be used for creation of an electronic funds transfer (EFT) or bank draft, and you authorize a debit of the full amount of this statement from your checking account. You agree that if the EFT or bank draft is returned unpaid, you will pay a service charge of $35 or the maximum allowed by law, which may also be debited from your account using an EFT or bank draft.

I have read and agree to the Red Tray i-drafts terms and conditions noted above.

First Name		Middle Initial		Last Name

Jerry Hayes OD