Bank Account Number. The seller should have a valid local account number.
Bank Account Number. Officer Phone Have you or your business ever declared bankruptcy? Yes No Chapter # If yes, under what name Date of filing: Date of discharge: State Has the company, any officers or owners of the company ever had either a judgment or a state or Federal tax lien filed against them personally or against any business entity associated with the person? If yes, where and when? If you are tax exempt, please attach certificate. Tax exempt number Do you require: Purchase orders Job numbers Do you limit people authorized to purchase for your company? If yes please attach list. NorCal Materials, dba Harbor Ready-Mix, dba XX Xxxx Co Inc complies with the Federal Equal Credit Opportunity Act.
Bank Account Number. BIC/SWIFT Code (further herein the”Author“) Xxxxxx conclude the following Contract for Work II. Subject and Purpose of the Contract 1. In compliance with the Copyright Act, the Contracting Parties hereby agree on the terms and conditions arising in connection with producing and using the “work” 2. The Author hereby undertakes to produce for the Commissioner, against consideration, the work resulting from the Author’s own intellectual creative effort. 3. The Author hereby undertakes to deliver a lecture at the conference Chinese language: Problems in Teaching and Translation for the Commissioner; the details of its extent, duration, time and venue are to be agreed upon between the Parties hereto. 4. The Commissioner shall be entitled to use the work for educational and research purposes, without requiring the author´s further consent, and for an unlimited period of time. 5. The date and the time of the accomplishment of the work: March 2019. 6. The manner of performance: the Author undertakes to produce the work in person. 7. The Commissioner undertakes to provide the necessary technical devices (room, equipment, the sound technology, the projection facilities, etc.). III. Consideration 1. In accordance with Article II of this Contract, the Commissioner undertakes to pay to the Author for the work produced and agreed upon in the amount of 130,-euros (one hundert and thirty euros) to the bank account number given in Article I of this Contract. 2. The Author’s entitlement to consideration shall arise subject to complying with all the terms and conditions of the Contract stipulated in Article II above.
Bank Account Number. This authorization is to remain in full force and effect until the Company has received written notification from me (or either of us), of its termination in such time and in such manner as to afford the Company and the Depository reasonable opportunity to process. Date Signature of Depositor (must be the same as on file at the Bank) Signature - if joint account Writing Agent’s Social Security Number Voided Check* Must Accompany Form *If you bank with a Credit Union, please contact them and ask them to provide you with the correct nine digit Routing Transit Number. Please tape a voided check here.
Bank Account Number. ⎕⎕⎕⎕⎕⎕⎕⎕⎕⎕⎕⎕⎕⎕ (Number of digits varies by banking entity) Name on Account: Please select one of the following payment options: ⎕ I want to enroll in automatic payment processing using the information provided above and I authorize Guardian Pharmacy to collect payment for charges not paid by my insurance company. Automatic payments will be processed based on the invoice due date. ⎕ I will manually submit monthly payments by the invoice due date and authorize Guardian Pharmacy to bill the payment method above if payment is not received by the invoice due date. Resident or Responsible Party Signature: Date: Please review the following statements. • Resident/Responsible Party agrees to pay for any purchases made from Guardian Pharmacy either directly or by facility personnel on Resident’s behalf and agree to pay the full invoice amount by invoice due date. • Resident/Responsible Party agrees that Guardian Pharmacy may bill the credit card or banking information listed above if payment is not received by the invoice due date. • Resident/Responsible Party understands and agrees that Guardian Pharmacy will discontinue service if payment is past-due and may send to collections and/or report to credit reporting agencies. A finance charge of 1.5% per month may be charged on balances over 30 days past due. • Some commercial insurance plans do not cover Long Term Care (LTC) Services. If your plan does not cover these services, Resident/Responsible Party agrees to pay the fee for LTC services received that may be reflected on your invoice. • Resident/Responsible Party understands that the use of Guardian Pharmacy as a provider of pharmaceuticals and other related services is optional. • Resident/Responsible Party understands and agrees that Guardian Pharmacy may, at the phone number provided above, make automated phone calls and send SMS text messages and other types of automated messages and reminders regarding billing and payment for Guardian Pharmacy's services. Please initial to acknowledge the above _________ Notice of Privacy Practices & Patient Bill of Rights ⎕ I certify that I have had an opportunity to review Guardian’s Privacy Notice at the below listed internet link and ask questions to assist me in understanding the rights relative to the protection of the above-named person’s health information. xxxxx://xxxxxxxxxxxxxxxx.xxx/hipaa-privacy-policy/ ⎕ I certify that I have had an opportunity to review Guardian’s Patient Bill of Rights at the below listed inte...
Bank Account Number. BIC/SWIFT Code: (further herein the”Author“) Xxxxxx conclude the following Contract for Work
Bank Account Number. TAX No./NIN (National I.D No.):................................................................... BVN:.............................................................................................................
Bank Account Number. Bank Account Type: (Circle One) Checking / Savings / Business Checking Customer Signature: Customer Printed Name: Date Signed: Please return this completed form to CKS Wireless by one of the following methods: Mail: PO Box 2125 Jacksonville, TX 75766 Email: xxxxxx@xxxxxxxxxxx.xxx Fax: 000-000-0000 Office Drop-off (Office hours are M – F, 8am to 5pm): 000 Xxxxx Xxxxxx
Bank Account Number. Number of people employed persons Competent manager’s name: …………………………………..……..….. Phone:................................... Fax:....................................... Email address:.……………………….……....……………..……….............................................................................................. Administrator’s name: …………………………………….………. Phone:................................... Fax: .................................... Email address:.……………………….……....……………..……….............................................................................................. Please send the Pro Forma Invoice to the following address:..................................................................................................... Voucher types and service charges Edenred Gift and Shopping Voucher Edenred Schooling Voucher (up to 31.12.2018) %+VAT %+VAT To be filled by Client in PRINTED letters or typed. Method of payment: Transfer
Bank Account Number. A copy of this executed Agreement must be provided to the person authorizing the debit from his/her account. Signature Date ONE TIME ACH PAYMENT AUTHORIZATION AGREEMENT CHECKING ACCOUNT (Please attach a voided check) Name as shown on checking account: Routing Number:
