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Card Registration and Account Setup Form

Prosperity Solutions LLC provides a card registration and account setup form for Freedom Club USA. The form requests the applicant's name, address, phone number, email, date of birth, and identification information such as a passport number, tax ID, Social Security number, or driver's license number. It includes fields for a card number, account number, signature, routing number and date.

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05C1LL473
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990 views1 page

Card Registration and Account Setup Form

Prosperity Solutions LLC provides a card registration and account setup form for Freedom Club USA. The form requests the applicant's name, address, phone number, email, date of birth, and identification information such as a passport number, tax ID, Social Security number, or driver's license number. It includes fields for a card number, account number, signature, routing number and date.

Uploaded by

05C1LL473
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

PROSPERITY SOLUTIONS LLC 404-428-3111

950 Herrington Road Suite C-97 Lawrenceville, GA 30044

CARD REGISTRATION FORM / ACCOUNT SET-UP FORM / CARD


Name Address City Phone # E-Mail State Zip cell wk hm

FCUSA

COUNTRY D.O.B. ___ ___ / ___ ___ / ___ ___ ___ ___ m m d d y y y y

Must supply at least ONE of the following


Passport I.D. # Fed Tax I.D. # Other I.D. # S.S. # Drivers License # Dr. Lic State , COUNTRY

SPECIAL FREEDOM CLUB USA REFERRER PROGRAM CARD APPLICATION Email to ProsperitySlns@[Link] or FAX to 770-717-2297

VM CARD # Account # 8 0 Signature

6278

9510

ACH - Routing # Date

111900756

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