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One Time Payment Authorization Form (Credit Card) CAMP HILL203 House AvenueCamp Hill, PA 17011Ph: 7177617113_HERSHEY50 E. Chocolate Ave. Hershey, PA 17033Ph: 7175331466MECHANICSBURG201 Bryant StreetMechanicsburg,
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This is a form that authorizes a one-time payment from a specific account.
Individuals or businesses who need to make a one-time payment from their account.
The form must be filled out with the payer's account information, payment amount, and authorization signature.
The purpose is to authorize a one-time payment from a specific account for a designated amount.
The form typically includes the account holder's name, account number, payment amount, and authorization signature.
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