Acceptance Form. I have read the Amended and Restated Change of Control Protection Agreement, dated as of January 1, 2012 (“Agreement”) and the accompanying Release [and the information attached as Appendix I] 3 and hereby accept the benefits provided under the Agreement, subject to the terms and conditions set forth in the Agreement and Release. Print Name:______________________ Employee Date:______________________ Signature:________________________ Employee STATE OF NEW YORK ) ) ss: COUNTY OF _________ ) On this ___ day of __________ _______, before me personally came ____________ to be known and known to me to be the person described and who executed the foregoing Release, and (s)he duly acknowledged to me that (s)he executed the same. ________________________ Notary Public
Acceptance Form. Account Number _________________________ __________________ hereby (i) acknowledges that it is a Licensee referred to in the Master Preferred Escrow Agreement effective June ____, 1996 with Data Securities International, Inc. as the escrow agent and BroadVision, Inc. as the Depositor and (ii) agrees to be bound by all provisions of such Agreement. [Licensee] By: --------------------------------- Name: ------------------------------ Title: ----------------------------- Date: ------------------------------ Notices and communications should be addressed to: Invoices should be addressed to: Licensee Name: ----------------------- ----------------------------------- Address: ----------------------------- ----------------------------------- ------------------------------------- ------------------------------------ ------------------------------------- ------------------------------------ Designated Contact: Contact: ------------------ --------------------------- Telephone: --------------------------- ----------------------------------- Facsimile: --------------------------- ----------------------------------- BroadVision hereby enrolls Licensee to the following account(s): Account Name Account Number ------------ -------------- ------------------------------------- ------------------------------------ ------------------------------------- ------------------------------------ ------------------------------------- ------------------------------------ BROADVISION, INC. DATA SECURITIES INTERNATIONAL, INC. MATERIALS TO BE DEPOSITED Account Number ______________________ BroadVision represents to Licensee that Deposit Materials delivered to DSI shall consist of the following: BROADVISION, INC. LICENSEE By: By: ------------------------------- ------------------------------- Name: Name: ----------------------------- ----------------------------- Title: Title: ---------------------------- ---------------------------- Date: Date: ----------------------------- ----------------------------- 25 EXHIBIT B DESCRIPTION OF DEPOSIT MATERIALS Account Number:_______________________________ Company Name: BROADVISION, INC. DEPOSIT TYPE: _________Initial__________ Supplemental ENVIRONMENT Host System CPU/OS_____________________ Version_______________ Backup________________ Source System CPU/OS___________________ Version_______________ Compiler________________ Special Instructions:_____________________________________ DEPOSIT COPYING REQUIREMENT: Hardware needed:_________________________...
Acceptance Form. To be read as part of the Agency Notice We agree to accept our appointment as your agent for the Facility on the terms above. Signed for and on behalf of AmBank Islamic Berhad (Company No. 199401009897 (295576-U)) Name: Designation:------- Date: (The remainder of this page has been intentionally left blank) SCHEDULE 3 OF PART B FORM OF MURABAHAH SALE CONTRACT (which is to be taken read and construed as an essential part of this Agreement) [to be inserted by the Bank] SCHEDULE B (Ownership Document of the Commodity) End of Part B for Tawarruq PART C OTHER TERMS ARTICLE XV
Acceptance Form. The Agreement will become effective upon the date of Supplier’s signature below. Instructions: Please sign, and email all pages of these Purchase Terms, and submit them with your Size Certification, Conflict Information Form, and Certificate of Insurance and Endorsements to: Xxxxxxxx_Xxxxxxxxxxx@xx.xxxxxxxxx.xxx. Supplier agrees that Customer’s Purchase Terms set out on the preceding pages apply to all business with Customer, and any Affiliate. In any PO issued by an Affiliate, the term “Customer” shall be construed to include only the Affiliate issuing such PO.
Acceptance Form. The bidder's proposal must be accompanied by the Acceptance Form (see Annex 5, attached) signed by a duly authorized representative of the bidder and stating: • That the bidder undertakes on its own behalf and on behalf of its possible partners and contractors to perform the work in accordance with the terms of the RFP; • The total cost of the proposal, indicating the United Nations convertible currency used1 (preferably US Dollars); • The number of days the proposal is valid (from the date of the form) in accordance with section 4.8 “Period of Validity of Proposals”.
Acceptance Form. I have read the Change of Control Protection Agreement, dated as of September 24, 2006 (“Agreement”) and the accompanying Release [and the information attached as Appendix I] and hereby accept the benefits provided under the Agreement, subject to the terms and conditions set forth in the Agreement and Release. Print Name: Date: Employee Signature: Employee STATE OF NEW YORK ) ) ss: COUNTY OF ) On this day of , before me personally came to be known and known to me to be the person described and who executed the foregoing Release, and (s)he duly acknowledged to me that (s)he executed the same. Notary Public
Acceptance Form. This Acceptance form is executed with reference to that certain Lease dated as of , 2013 by and between 0000 XXXXXX XXXXX XXXXXXX, LLC, a Delaware limited liability company (“Landlord”), and HYPERION THERAPEUTICS, INC., a Delaware Corporation (“Tenant”). Terms defined in the Lease and the exhibits thereto shall have the same meaning when used herein. Tenant hereby certifies to Landlord that Tenant has inspected the Premises as of (the “Date of Inspection”). Tenant further acknowledges that Tenant hereby accepts the Premises in its existing condition, subject to the provisions of the Lease. The person executing this Acceptance Form on behalf of Tenant represents and warrants to Landlord that such person is duly authorized to execute this Acceptance Form and that this Acceptance Form has been duly authorized, executed and delivered on behalf of Tenant. THIS ACCEPTANCE FORM is executed by Tenant as of the Date of Inspection. TENANT: HYPERION THERAPEUTICS, INC. By: Name: Its: EXHIBIT E TENANT IMPROVEMENT WORK — WORK LETTER
Acceptance Form. The undersigned agrees to participate in one or more of MedImpact’s pharmacy networks and to be bound by the MedCare Pharmacy Network Agreement attached hereto and made part hereof without any modifications, deletions, or additions. By signing below, the undersigned represents and warrants that it has received and read the MedCare Pharmacy Network Agreement. By signing below, the undersigned represents and warrants that the undersigned has been afforded ample opportunity to obtain legal or other assistance in reviewing and interpreting the MedCare Pharmacy Network Agreement. The undersigned represents and warrants that the information contained herein is true and accurate. NCPDP# (formerly NABP#) Corporate Name Pharmacy Name (DBA) Pharmacy Address City, State, Zip Code Mailing Address City, State, Zip Code Phone Number Fax Number Email Address DEA Number State Pharmacy License Number Medicare ID Number Medicaid ID Number Federal Tax ID Number Contact Name and Title Hours of Operation / Delivery: Yes No Pharmacy Authorized Signature Printed Name and Title Date MedImpact Authorized Signature Printed Name and Title Date Exhibit 1 WASHINGTON PHARMACY NETWORK ADDENDUM TO MEDCARE PHARMACY NETWORK AGREEMENT In the event any provision of this Addendum conflicts with the terms of the Agreement, the terms of this Addendum shall control with respect to Plans subject to the applicable Washington Law. To the extent that Member Pharmacy provides Pharmacy Services to Eligible Persons of a health carrier, health carrier service contractor, health maintenance organization (“HMO”), or other insurer licensed under Washington Law (collectively and/or individually, “Payer”), Member Pharmacy agrees to comply with any requirements for participation as a Member Pharmacy in Washington as required by applicable Law. Without limiting the generality of the foregoing, Member Pharmacy agrees as follows:
Acceptance Form. If you have any questions, please do not hesitate to ask. We look forward to seeing you at NAPO2018! Sincerely, Xxx Xxxxxxxx Meetings & Operations Manager, National Association of Professional Organizers (NAPO) Phone: (000) 000-0000 | Fax: (000) 000-0000 | Email: Xxx.Xxxxxxxx@XXXX.xxx 1 “Speaker” throughout this document refers to moderators and panelists as well as Concurrent Session speakers.
Acceptance Form. This Acceptance form is executed with reference to that certain Lease dated as of , 2007 by and between THE BOARD OF TRUSTEES OF THE XXXXXX XXXXXXXX JUNIOR UNIVERSITY (“Landlord”), and TESLA MOTORS, a (“Tenant”). Terms defined in the Lease and the exhibits thereto shall have the same meaning when used herein. Tenant hereby certifies to Landlord that Tenant has inspected the Premises as of (the “Date of Inspection”). Tenant further acknowledges that Tenant hereby accepts the Premises in its existing “AS-IS”, “WHERE-IS” condition, and “WITH ALL FAULTS”. The person executing this Acceptance Form on behalf of Tenant represents and warrants to Landlord that such person is duly authorized to execute this Acceptance Form and that this Acceptance Form has been duly authorized, executed and delivered on behalf of Tenant. THIS ACCEPTANCE FORM is executed by Tenant as of the Date of Inspection. TENANT: By: Its: By: Its: Exhibit D DETERMINATION OF PREVAILING MARKET RENT
