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Complete and return this form only if you would like Katance, Inc. to electronically withdraw your monthly Retiree insurance premiums directly from your bank account. You may also use this form to report changes/cancellations to this process once you are enrolled.
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3500 Kyoto Gardens Drive
Palm BeachGardens, FL 33410
Tel: 1-866-201-7460
Fax: 1-866-201-7461
Email:requests@katance.com