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T will be used to obtain personal and financial information of the undersigned. The authorized parties listed below shall use all reasonable means to insure the information provided is used for the purposes set out below. The parties listed below shall not be liable and shall be held harmless from and for any claims of loss or damage caused in connection with the use of this authorization. I hereby authorize of (whose phone number is and fax number is ) and/or any designated agent, assistant, Ti.

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