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Participant Authorizing Signature Printed Name Date INTERNAL USE ONLY PSC has authenticated the person signing this form. A reasonable opportunity to act upon it. AUTHORIZING SIGNATURE The undersigned certifies that the information contained herein is accurate and complete. Electronic Funds Transfer EFT Authorization BENEFIT PAYMENT PHONE 888-719-8932 FAX 866-582-5080 DIRECT DEPOSIT Participant Service Center Mailbox TX 1-J208 P. JPMorgan Chase Bank N.A. is directed to initiate payments or...
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