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Fillable PROGRESSIVE INSURANCE CLAIMS MEDICAL SUPPLIER ...

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Print Form PROGRESSIVE INSURANCE CLAIMS MEDICAL SUPPLIER AUTHORIZATION FOR PAYMENT BY ELECTRONIC FUNDS TRANSFER (EFT) This form must contain an original signature by the authorized representative of your company. You may fill out the form on-line, print, sign and submit electronically by converting to a pdf. You may also send the form back via fax or regular mail after signing. Email:...
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