I, (Participant) hereby authorize (company) to communicate with my former CDS vendor regarding the following information from my records. Employer/Employee tax information regarding the CDS program for the period of time from to . The purpose of this disclosure is for payment and or transfer of tax related documents concerning the involvement in the CDS program with the following vendor.
Former Contact Person
Former Vendor Contact Number
Participant Address
Participant Contact Number
Participant DCN
