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EFT AUTHORIZATION FORM

EFT AUTHORIZATION FORM

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EFT AUTHORIZATION FORM Insured Name: _____ Policy # _____ (last name) (first name) ... I authorize and request the Commerce Insurance Company (Commerce) to debit my bank account as payments on this policy or its replacement become due. If a debit is dishonored, the bank will not have any liability, even if the dishonored payment causes the ...

  Bank, Authorization, Debit, To debit

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