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Authorization to Bill Credit Card 7RGD ¶V DWH , KHUHE DXWKRUL H 7KH KLOGUHQ¶V RVSLWDO RI 3KLODGHOSKLD WR FKDUJH P FUHGLW FDUG DFFRXQW in the amountof For the observership.
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For medical expensesof Amount Name of Child The expenses include both hospital and physi cian charges. Account Number Expirationdate Name.