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Get Telecheck Forgeryidentity Theft Affidavit Form

One No. Joint Account Holder First Name Daytime Telephone No. Account Holder & Joint Account Holder ID/Drivers License #s Cell Phone No. Account Holder & Joint Account Holder Social Security #s Name of Financial Institution Banking Information Is this Account Closed? Bank Routing Number Affected Bank Account Number Affected Check Series Reported Lost or Stolen Yes Y No N Beginning Check # / End Check # Please Include the Following for Forgery or ID Theft Check Number Date Amo.

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