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Bank Transfer & ACH Authorization Form

I                                                          authorize Smile Group LLC, to electronically debit my bank account

According to the terms outlined below. I acknowledge that electronic debits against my account must comply with United States law.

Bank Information

Bank Name

Account number

Routing number

Card Authorization Form

I                                                               give permission to Smile Group LLC, to charge my card for the my

purchases. My card details will be stored in my profile and will only be used for my future purchases.

Card Information

Account type

Card number

Exp Date


Name of card

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