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By completing this secured form, you authorize American Ventures, Inc., D/B/A Advanced Insurance Services to facilitate in providing your checking information as indicated below.

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Set up EFT for monthly payments with Finance Company To set up auto deductions for an audit payment To pay an audit in full To set up EFT payments with insurance company I authorize uploading payment from my checking to the insurance company

Advanced Insurance Services does not accept payments by check, this information is being accepted as a customer service facilitation only.

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