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QVC$Dental$Health$Membership$ Direct$Debit$Request$ PO$Box$$$463Rockingham$$$6968 !$$$$0865554900 PLEASE&COMPLETE&FORM&IN&BLOCK&CAPITALS& & Commencement&Date&All$direct$debits$will$be$collected$on$or$around$the$5th$of$each$month$For$QVC$only:$

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