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5dimes Authorization Form

5dimes Authorization Form

Use a 5 dimes app template to make your document workflow more streamlined.

Number Phone Number *Valid phone number is required as may be called for verification purposes Address City State ZIP Code Only cards under the account holder's name are allowed to deposit. Transactions processed using third party cards are deemed as high risk and will ban your account and personal information from future credit card deposits. Credit Card Number Expiration Date #1 #2 #3 I , do hereby authorize The 5Dimes Group and any other billing agencies associated to their operation, to...
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