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Get and Sign Bank of America Borrowers Authorization Form
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City
State
Zip Code
5.
If reimbursement is needed for payments that you have made during an approved benefit period, may we place the
funds in your Bank of America checking account? Yes No
6.
If yes, please sign your name and list your Bank of America checking account number below.
(Your Signature)
(Your Checking Account Number)
INSTRUCTIONS – Please read before filling out this benefit activation form.
1.
There is a waiting period. You must be disabled and under the care of a...
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