Beneficiary Name. Amount of Wire: $-------------------- Beneficiary Bank:------------------ Account Number:--------------------- City and Sate:----------------------- Beneficiary Bank Transit (ABA)#: - - - - Beneficiary Bank Code (Swift, Sort, Chip, etc.): ------------ (For International Wire Only) Intermediary Bank:------------ Transit (ABA)#: ------------------------- For Further Credit to: ---------------------------------- Special Instruction: ------------------------------------------ By signing below, I (we) acknowledge and agree that my (our) funds transfer request shall be processed in accordance with and subject to the terms and conditions set forth in the agreements(s) covering funds transfer service(s), which agreements(s) were previously received and executed by me (us).
Beneficiary Name. Address: Relationship: Signature of Spouse (if beneficiary other than spouse): I hereby elect to participate in the ValueClick, Inc. Employee Stock Purchase Plan (the “Plan”) for the offering period specified above, and I hereby subscribe to purchase shares of Common Stock of ValueClick, Inc. (the “Common Stock”) in accordance with the provisions of this Authorization Form and the Plan. I hereby authorize payroll deductions from each paycheck during the offering period following my enrollment in the Plan at the percentage indicated above. I understand that, pursuant to the Plan, no more than $7,500 (U.S.) may be withheld from my eligible earnings for the purchase of Common Stock in any single purchase period. I understand that all payroll deductions shall be credited to my account under the Plan and will be accumulated for the purchase of shares of Common Stock at the applicable purchase price determined in accordance with the Plan. I further understand that, except as otherwise set forth in the Plan, shares will be purchased for me automatically on each purchase date unless I cease to participate in the Plan. This authorization will stay in effect until I change it or cease to participate in the Plan. If ValueClick determines that it is impractical or prohibited by applicable law from withholding any amounts from my paycheck for the purposes of the Plan, then I agree to execute such documents as it may determine are necessary or appropriate to set aside the appropriate amounts contemplated herein to purchase shares under the Plan on my behalf. I understand that I may change the rate of deductions for future offering periods by submitting a new Authorization Form and any such change will be effective as of the beginning of the next offering period. I understand that I may withdraw from the Plan at any time up to 10 days prior to the last day of an offering period and elect to have ValueClick refund all my payroll deductions for the current offering period. However, I may not rejoin that particular offering period at any later date. Upon the termination of my employment for any reason or my loss of eligible employee status, my participation in the Plan will immediately cease, and all my payroll deductions for the purchase interval in which my employment terminates or my loss of eligibility occurs will be refunded. In the event of my death, I understand my payroll deductions will be handled in accordance with the Plan. I have received a copy of ValueClick’s ...
Beneficiary Name. Guardian Life of the Caribbean Beneficiary Address: #0 Xxxxxxxx Xxxxx, Xxxxxxxxxxxx Beneficiary Account No.: 100004013360602 Beneficiary Bank: RBC Royal Bank Trinidad & Tobago Limited Declaration Until cancellation, expiry or termination of these instructions or this service, the Bank is authorised to debit from the named account the stated amount in the manner specified for application as instructed and the Bank’s usual charges from time to time. It is a condition that debits and payments under these instructions will be made by the Bank only if sufficient funds are available for use in the named account, as at the debit due dates and such debit activity can be facilitated in the account based on the account status. If, as at the debit due dates, the named account contains insufficient funds to satisfy these instructions, then the Bank may in its sole discretion re-attempt these instructions for three (3) consecutive days thereafter. The Bank will not be liable for failure of payment due to insufficient funds in the named account and/or if debit activity is restricted in this account. The named account may be charged an additional fee for each failed instruction (including any re-attempt) in such circumstances and where applicable. The Bank in its sole discretion reserves the right to not process instructions if sufficient funds are not available for use, to also cover the applicable standing order fees/service charges. The undersigned may terminate the standing order by written notice to the Bank, in such form as the Bank may prescribe. If the law where the Bank is located provides that notice given electronically may meet the requirement for written notice if certain conditions are met, the undersigned may provide notice to terminate electronically, provided that the conditions set out in law are met and the Bank agrees to accept notice given electronically. The undersigned understands and agrees that the Bank may terminate the standing order:
Beneficiary Name. Beijing Red Yellow Blue Technology Development Co., Ltd. Beneficiary Bank Name: Beijing Fangzhuang Sub-branch of China Merchants Bank Co., Ltd. Beneficiary Account Number: 8666 8013 7810 001 Within the license term agreed upon hereunder, Party A shall notify Party B in writing of any changes in the designated bank account in advance.
