OSHA Resource Group

Letter Of Authorization


I , authorize The Medical Mandate Advisors D.B.A OSHA Resource Group to charge my Credit Card/ACH Bank Account indicated below for the subscription of ()
$ starting on August 17, 2022
.

                          

Billing Information


Billing Address

 

Phone #  

Email:

 

 

Card/Account Details                


 

Account Holder Name  

Account# [LAST 4]   

 

 

DATE August 16, 2022

Leave this empty:

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Signature Certificate
Document name: Letter Of Authorization
lock iconUnique Document ID: a79469ae5d12bf6a618822d648a0ca419de619ef
Timestamp Audit
December 14, 2020 3:59 pm PDTLetter Of Authorization Uploaded by Rishawn Newman - admin@osharesourcegroup.com IP 24.253.61.228