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Get Premium Authorization Form
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How to fill out the PREMIUM AUTHORIZATION FORM online
Completing the PREMIUM AUTHORIZATION FORM online is a straightforward process that supports the Eaton County 4-H Jr. Livestock Market Sale. This guide provides clear instructions for each section of the form to ensure your submission is accurate and timely.
Follow the steps to successfully complete the form.
- Click the ‘Get Form’ button to download the form and open it for editing.
- In the first section, specify the member's name for whom you wish to contribute a premium by filling in the blank space provided. This ensures that your support is directed correctly.
- Next, indicate the amount you intend to contribute, ensuring it meets the minimum of $10. Enter the dollar amount in the provided field.
- Choose your payment method by selecting one of the options. You can either choose to mail a check or authorize a charge. If mailing, indicate that the check will be sent with a 4-H member and make it payable to GreenStone FCS. Alternatively, mark the option for charging your account.
- Provide your signature to authorize the premium payment, followed by the date on which you are filling out the form. This step is crucial for validating your authorization.
- Fill out the 'Name for use in advertising' section if applicable. This is where you can state how you wish to be recognized.
- Complete the contact information, including your name, address, and phone number. Note that these fields are marked as required.
- Once all the fields are complete, review your form for accuracy. Then, you can save the changes, download it, print it, or share it as needed.
Complete your PREMIUM AUTHORIZATION FORM online today and support the Eaton County 4-H Jr. Livestock Market Livestock Sale.
Related links form
By completing and returning the Authorization Agreement for Preauthorized Payments form (SF-5510), you're authorizing the Centers for Medicare & Medicaid Services (CMS), the Federal agency that runs the Medicare program, to deduct your monthly Medicare premium from your bank account.
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