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Authorization Agreement for Automatic Withdrawal of Funds Envelope # (leave blank if not applicable) Name (Please print) Address City State Zip Please debit my contributions from my (check one): Checking
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01
Obtain a copy of the authorization form ver2pub.
02
Read the instructions and requirements given with the form carefully.
03
Fill out the personal information section accurately, including your full name, address, and contact details.
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Provide the necessary information regarding the authorization request, such as the reason for authorization and the duration needed.
05
If applicable, attach any supporting documents or evidence to strengthen your authorization request.
06
Review the completed form and ensure all information is correct and legible.
07
Sign and date the form to certify its accuracy and your consent.
08
Submit the filled-out authorization form to the designated recipient or authority as specified in the instructions.
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Keep a copy of the form and any supporting documents for your records.
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