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The IRS does not require your consent to any provision of this document other than certification requested to avoid backup withholding. Member Application and Ownership Information Birth Date SSN/TIN E-Mail Work Cell State Expiration Occupation Membership Eligibility Primary Name Address City State Zip Home Phone ID Type/ Employer How will you access this account Visa Debit Card must have checking account otherwise ATM Card will be issued. X AUDRE Name 2 Joint Owner Custodian POD Name 3...
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