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Bank Draft Agreement I, ___, agree to allow Leah B. Gilliam, MD, PC to draft from my bank account / credit card (circle one) the amount of $___ once per month in order to cover Direct Primary Care
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Gather all the necessary information such as names, addresses, and contact information of the individuals involved in the relationship.
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Start by providing your own personal information in the designated fields on the form.
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Proceed to fill out the information of the other individual in the relationship, making sure to provide accurate details.
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Answer any questions related to the nature of the relationship and how long it has been established.
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Double-check all the information filled out on the form for accuracy and completeness before submitting.

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Individuals who are looking to establish or verify a basic checking relationship with another party.
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Form basic checking relationship is a document used to verify the legitimacy of certain transactions or relationships for regulatory purposes.
Individuals or entities engaged in regulated activities or transactions that require relationship verification are required to file this form.
To fill out the form, you need to provide accurate details regarding the parties involved, the nature of the relationship, and any relevant transactions.
The purpose of the form is to ensure compliance with regulations and to prevent fraudulent activities by verifying the authenticity of relationships.
The form typically requires information such as names of the parties, their addresses, relationship details, and relevant transaction data.
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