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- PDF Electronic Debit Service Agreement - Washington State Health Care ...
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C debit service (EDS) allows PEBB subscribers to have monthly payments automatically taken from a checking or savings account. To enroll in EDS, please complete this form. Type or print clearly in black ink. I am submitting this form to (check one): q Start an electronic debit service from my bank account. q Change my electronic debit service bank account. Subscriber s Information Subscriber s name (please print) PEBB account number or subscriber s Social Security number Bank Account Inf.
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