New Order
	Reorder
Customer Name:
Account Number:
	If you would like your phone number printed on your checks, please list that below:
Phone Number:
Check Style:	ORAB Spirit Checks COMET Spirit Checks American Flag Green Granite Grey Antique Clouds Citizens Plus (Members Only) Sports Garden Retro Wildlife Wave
Check Type:	200 Wallets - 1 Box 160 Duplicates - 1 Box
# of Boxes:	1 2 3 4 5 6 7 8 9 10
Start Number:

Your check order will be ready for pick-up at the bank two business days
from the day we receive your order form.

Your completed order form can be either mailed, faxed, or dropped off
to Citizens State Bank at your convenience!

Mail Form To: Citizens State Bank Attention: ¢SiBle Checks Order 808 3rd Avenue PO Box 130 Sheldon, IA 51201 Fax Form To: 712-324-5382 Attention: ¢SiBle Checks Order	Thank you for Your Interest In

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