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Get M&t Bank S-090965 2009-2024

Yee Information EMPLOYEE NAME SSN ADDRESS (STREET) CITY STATE ZIP STATE ZIP Company Information COMPANY NAME COMPANY ADDRESS CITY Deposit Instructions AMOUNT TO BE DEPOSITED IN HEALTH SAVINGS ACCOUNT $ FREQUENCY ACCOUNT NO. M&T Bank PO Box 2032, Milwaukee, WI 53201 Transit / ABA # 031302735 Signature I hereby authorize the above company to deduct the above amount(s) from payments that would otherwise be due to me and cause such amounts to be deposited to my M&T Bank HSA account noted.

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