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                    "text": "CHECK DISTRIBUTION INSTRUCTIONS: Date Required ___\n□ Mail □ Mail with Attachment(s) □ Pick-Up: Call ___ x",
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                        "label": "23/1 23/1 41 5 6 /75 \" 8(9 2:17;<& = >/ ############################ ?#########",
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                    "text": "PLEASE TYPE OR PRINT LEGIBLY",
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                            "text": "SUBMIT ORIGINAL TO ACCOUNTS PAYABLE WITH REQUIRED SUPPORTING DOCUMENTATION. TO ENSURE PROMPT",
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                    "text": "SUBMIT ORIGINAL TO ACCOUNTS PAYABLE WITH REQUIRED SUPPORTING DOCUMENTATION. TO ENSURE PROMPT PAYMENT, COMPLETE ENTIRE FORM AND OBTAIN NECESSARY SIGNATURES. ALLOW 3-5 DAYS FOR PROCESSING.",
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}