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Return completed form and voided check to Tina West. Agar Health Services, 205 SE Wilson Ave. STE 1, Bend, OR FAX: 541-312-0077 AUTOMATIC DEBIT AUTHORIZATION FORM Company Name Company ID Number I

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Ageia Health Services LLC is a healthcare company that provides various medical services to patients.

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Ageia Health Services LLC is required to file its annual report and any other required filings with the relevant government agencies.

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The purpose of Ageia Health Services LLC is to provide healthcare services and improve the overall wellbeing of patients.

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The specific information that must be reported on Ageia Health Services LLC may vary depending on the applicable regulations and requirements. Generally, it includes financial statements, ownership details, operating activities, and any other information requested by the relevant government agencies.

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