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Get Visio For Ach Transfer Form

Ink to complete the form. Please write only in the spaces provided. My ADP BL Number: Authorization for Recurring Bank Account Debits I hereby authorize ADP National Account Services to automatically ACH debit my checking or savings account (indicated below) on a recurring monthly basis for my elected benefit premiums for health insurance coverage. I agree and understand that: I will be notified in writing once this form has been successfully processed. The ACH draft date is predetermined by.

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