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Get AZ Sedgwick Direct Deposit Form 2015-2024

Al_______ Last Name___________________________ SSN: ______________________________ Agreement I authorize Sedgwick and my Employer, at their discretion, to deposit my approved disability benefit payments into my account as indicated below. This authorization will remain in effect until I give written notice to Sedgwick either to change or cancel this authorization, in such time and in such manner as to afford Sedgwick a reasonable opportunity to act on it. I understand that my deposit will not.

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