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Last four SSN: xxx-xx-

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Please Confirm full name and signature.

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I agree that I am and I agree this is a legal representation of my signature for all purposes just the same as a pen-and-paper signature

I agree that I am and I understand this is a legal representation of my signature

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March 19, 2026 10:59 am PDT

Discover Products Opt In_6498 Uploaded by Settlement Mailboxes - [email protected] IP 52.252.236.64