Draft Check Authorization Form

Casa Theodore, Inc

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as a draft check. This draft will be automatically debited from myaccount. I understand that I presently have these funds available in my account to process thisdraft. This is to be done on a one time only basis. This draft authorization is solely for the use ofCasa Theodore, Inc. for:

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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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