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Y2K Statement
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Check Authorization Form
Name
Date

Company Name
Amount Authorized

Account Signer's Name
Bank Name

ABA Routing Number


(This is a 9 digit number at the bottom of check)

Account Number


(This is found at bottom of check)

Check Number


(This is the check number on the check for us to use)

NOTE: Please fax a voided check to 954-771-1777, but to do not mail check.

Any questions, please call (954) 771-2100

 
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