ACH/EFT Authorization Form - Black Bear Fuel
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ACH/EFT Authorization Form

ACH/EFT Authorization Form

Please complete the form below, sign with the account holder’s signature on the field indicated. Attach a photo copy of a void check and the signed ACH/EFT form.

Your completion of this authorization form helps us to protect you, our valued customers, from fraud. All information entered on this form will be kept strictly confidential by Jus-Sar Fuel, Inc.

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