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ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION

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Page 1: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION

Page 2: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION

Page 3: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION

Page 4: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION

Page 5: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION

Page 6: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION

Page 7: ProSites, Inc. · 2014-08-27 · General and Cosmetic Dentistry 8770 Cuyamaca Street, Suite 1 Santee, CA 92071 7 FossettDDS.com AUTHORIZATION FOR RESPONSIBLE PARTY AND CANCELLATION

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