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Get USDA NFC-1321 2001-2024

60 ENROLLEE’S INFORMATION NAME (First, Middle, Last) ENROLLEE’S SOCIAL SECURITY NUMBER STREET ADDRESS TELEPHONE NUMBER CITY STATE ZIP CODE ACCOUNT INFORMATION BANK NAME BANK TELEPHONE NUMBER (Area Code and Number) BANK ROUTING NUMBER ACCOUNT NUMBER ACCOUNT HOLDER’S NAME TYPE OF ACCOUNT (Check one) CHECKING ACCOUNT SAVINGS ACCOUNT AUTHORIZATION I hereby authorize the National Finance Center/DPRS Billing Unit to initiate a deduction from my account and the financial institutio.

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