Hi there, @bhughes406.
Thanks for sharing the complete details of your concern here in the Community. If you're having issues with the check alignment in QuickBooks Online (QBO), I have a list of solutions that might help. In this way, it will print out without any hassles.
For fine-tuning the check alignment in QuickBooks, the only variable we can adjust is the amount. Plus, the default values for the horizontal and vertical offsets are 0.0, which works well with forms and printers.
Please note to use Adobe Reader to print the standard and voucher checks. And make sure it gets updated regularly. Then let's adjust the scale settings in your print dialogue box. Feel free to click this page for the detailed steps: Configure your print settings for printing checks in QuickBooks Online.
In addition, we can read the following articles for a few more ideas on how to update Adobe Reader/Acrobat and fix printing issues for browsers for windows.
If you have any questions or concerns, please let me know. Every time you need a hand, I'll be here to provide it. Stay safe.