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Making any false, fictitious, or fraudulent claim or statement to the united states is a crimeand may be prosecuted. All plans come with a 15 day money back guarantee! In signing this form, i authorize this payment to be sent to the financial institution named in part b above, to be deposited into the … The financial institution should mail the completed form to the government agency identified above. Then take or mail this form to the financial institution. The completed form will be … Then take or mail this form to the financial institution. With the document signer, easily create your signature with your finger or a stylus, then apply it or your initials directly to the form.

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