Check Payment Authorization Form

Form Number : CL900 Rev:2025CL001.001

Important Notice: Please Read

Note: All information is transmitted securely, with additional layers of protection applied to certain fields to ensure your data remains safe. Please refer to our Privacy Policy for more details.

(Fields will be displayed based on your selections.)

For the best experience, we recommend filling out the forms on a desktop.

This form is separate from your account and is designed for clients who send checks for their invoices instead of using online payment tools.

Only checks from US banks are accepted.

We also accept money orders if this form is filled out.

Please note:

• We do not accept cash at our office locations or keep cash on-site.

• All checks should be made payable to Prismroute.

• In the memo section, you can write the invoice number, but please do not write it in the specified field on the form.

• Ensure you input your account number correctly. You can find it on your invoice or by contacting us at crm@prismroute.com.

• You should fill out this form whether you are logged in or not.

• Fields marked with a lock icon (🔒) are secured with an additional layer of protection to safeguard Personally Identifiable Information (PII) such as addresses, account information, and bank details.

• All checks should be sent to our Administration Office. Please do not send checks to other locations.

• All information on this form is secured.(Read the Privacy Notice)

• Please send check to this address:

  
  

  610 Market Street, Ste 104 Kirkland, WA 98033

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1-Fillers' Information

Enter your account number (choose the first part and enter the remaining digits).