Example: dental hygienist

Automatic Payment Option All account information will ...

Automatic Payment Authorization By providing my bank account or credit card account information to Reliant and signing in the space provided, I hereby authorize Reliant to charge my account in the amount of my monthly invoice. For bank drafts, I authorize Reliant to keep my signature on file as a record of my authorization to charge my bank ...

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  Direct, Life, Automatic, Card, Authorization, Reliant, Credit card, Of lien

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