Cancel. I hereby authorize Meritain Health, 000 Xxxxxxxxx Xxxxxxx, Xxxxxxx, XX 00000, hereinafter called COMPANY, to initiate debit entries from my account indicated below and the depository name, hereinafter called DEPOSITORY, to debit the same account.
Appears in 3 contracts
Samples: Employer Application, Employer Application, Employer Application
Cancel. I hereby authorize Meritain Health, 000 Xxxxxxxxx Xxxxxxx, Xxxxxxx, XX 00000The Xxxxxx Compnay, hereinafter called COMPANY, to initiate debit entries from my account account, indicated below and the depository name, hereinafter called DEPOSITORY, to debit the same account.
Appears in 1 contract
Samples: Employer Application
