Acceptance Signatures. By signing below, Practice and Patient represent that they fully understand and freely covenant to accept the rights and obligations under this Agreement. Specifically, Patient, or Patient’s legal representative, represents that he or she has had the opportunity to review the Agreement thoroughly and discuss any and all questions.
Acceptance Signatures. To indicate your acceptance of this agreement, please sign and return this Confirmation Agreement and Credit Card Authorization Form by (Texas Glory). By returning the signed agreement, you will enable us to establish these arrangements on a definite basis. Approved and authorized by (Texas Glory). Contact Name: (Print) _Xxxx Xxxxx Title: (Print) General Manager Signature: Date: 01/11/2021 Xxxx Xxxxx Hotel Contact Name: (Print) Signature:
Acceptance Signatures. By signing below, You represent that You fully understand and freely agree to accept the rights and obligations under this Agreement and that You have had the opportunity to ask questions and have those questions answered.
Acceptance Signatures. By signing below, Practice and Patient represent that they fully understand and freely covenant to accept the rights and obligations under this Agreement. Specifically, Patient, or Patient’s legal representative, represents that he or she has had the opportunity to review the Agreement thoroughly, discuss the Agreement with the Physician (or designee), and has had any and all questions regarding the Agreement answered to Patient’s satisfaction. Olive Health, PLLC d/b/a Olive Health Direct Primary Care Patient or Patient’s Legal Guardian Signed: Xxxx Xxxxxx, Member of Olive Health, PLLC Signed Printed Printed Date Date Appendix A
Acceptance Signatures. Executed the day and year set forth above. THRIGE ELECTRIC A/S NDC AUTOMATION, INC. By: /s/ Mogens From By: /s/ Ralph Dollander --------------------------- ------------------------------ Title: President Title: President ------------------------ --------------------------- ATTACHMENTS SCHEDULE A : List of Products SCHEDULE B : COMPANY's liability insurance with endorsement for vendor
