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* By checking this box and submitting this claim information; you are authorizing Global Debt Solutions, Inc. to proceed on behalf of the above referenced creditor for the purpose of collection.
* You hereby place the above account with Global Debt Solutions, Inc. for the purpose of recovery and agree to pay in accordance with the fee arrangements.
* If this account is withdrawn before Global Debt Solutions, Inc. recommends its closure, we reserve the right to apply our fees to any monies collected, or to all return of merchandise which has been authorized and received. Our fees will be based on one-half the invoiced amount of the merchandise.
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