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Third Party rewrite Authorization

This is for loan rewrites by a third party only, NOT for Pickups!

First Name

Last Name

code

Authorized

Email

Loans

Agreed

I understand and agree that (a) new ticket(s) will be issued to my surrogate. I also agree to the terms and conditions of the rewritten loan(s) pursuant to current *California Laws. Surrogates MUST be over the age of 18 and must provide current government ID. CASH ONLY.

*To view a copy of the Contracts General Provisions, Click Here