If you are a new customer, please call the bank to set up your initial check order
at 887-7811 or 888-887-2341

Please complete this form, print it, then mail it or deliver it to one of these
West Iowa Bank locations:

PO Box 407
West Bend, IA 50597
(888) 887-2341
PO Box 100
Algona, IA 50511
(515) 295-7600
PO Box 79
Fenton, IA 50539
(515) 889-2231
PO Box 116
Bode, IA 50519
(515) 379-1111

All information is required for order processing.

Account # 
Starting Check # 
Home Telephone #
Work Telephone # 
Single
200 Checks
400 Checks
Duplicate
160 Checks
320 Checks
Colors Available:
Gold
Plain Blue
Gray
Green
Burgundy
Blue Cloud
Flag
Pastel Shapes
Wildlife

For the bank to process a re-order, please type name and address as printed on your re-order form or check.  Maximum of 5 lines.  If you wish to change any information or the style of your check, please contact our bank, either in person or by phone.

Your checks will be printed at the West Iowa Bank.  Your account will be debited for the total of the order and you may pick your checks up at the bank.  Additional fee may be charged for postage if order is mailed out.

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