as a draft check. This draft will be automatically debited from my
account. I understand that I presently have these funds available in my account to process this
draft. This is to be done on a one time only basis. This draft authorization is solely for the use of
Casa Theodore, Inc. for:
Note: Please DO NOT send the original check when submitting original paperwork by mail.
Please retain a copy of this for your records.
Please make check payable to Casa Theodore, Inc.
Place your check here
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