TMAN Membership Payment by E-Mail Form

I wish to place an order, and hereby authorize RTI Inc. to duplicate the following check information in bank draft form. I will retain my original information for my/our record of this transaction. This authorization is for this transaction only. No other bank drafts may be created without my/our direct authorization.

Mr.  Mrs.  Ms.  Miss  Dr.  
Last Name   First 
Address   
City        State   ZIP 
Phone No.    Fax No. 
E-Mail    


Select one         

General Membership $19.95/yr
Charter Membership (non-school owner) $39/yr
Charter Membership (School Owner) $99/yr
Martial Arts Scout $50/yr





Account Name       
Bank Name          
Bank Phone #:       (800# on bank statement)
Check Number       
Branch Code Line 1 (small #'s under check #)
Branch Code Line 2 (small #'s under check #)
Transit Number     (all digits at bottom of check)
Transit Number     (enter above numbers again)
Purchase Amount     (total of items being purchased)
Memo to be printed on draft check 

I understand that by submitting this authorization form via electronic means that this authorization shall be considered the same as if I had signed and dated this authorization. I further understand that RTI, Inc. will charge me $25 if this check draft is returned for insufficient funds.