Name (as it appears on your bank statement)

Address  (as it appears on your bank statement)

Add'l. Address

City   State   Zip + 4

Bank Routing Number  (9 Digit Bank Identifying Number)

Bank Name 

Your Phone Number (Your bank may call you to verify)

Bank Account Number  (Your checking account number)

Amount to be Drafted   in payment for OFT Order #

Type of Account (check one)
  Consumer Checking           Consumer Savings          Business Checking          Business Savings
I, the undersigned, agree to allow OLD FATHER TIME to electronically debit my bank account or create and process a demand draft against my bank account in the amount shown above, on or after today's date. I am providing a copy of this transaction to Old Father Time by mail or email.  Old Father Time may (if requested), provide it to the card processing bank.

     
Signature                                                                                                                  Date
(The information on this form is not sent through the internet, it is only intended for PRINT) Please Complete this Form on your screen, then print it and send by fax 1-(888) 668-1150, postal mail, or email attachment to us at watchmakers@oldfathertime.com