Business Type. New Business Transfer of Servicing Our fees for ongoing Client Support Strategies: Please tick the box for the strategy you require Client Support Strategies Fees* Strategy required Digital Vero only + monetary target No regular reviews, self monitoring Web portal & App, impulseSave®, client rewards, values to target 0.35% Virtual Vero or any other suitable provider At least 12-month review virtually e.g. on Teams Product documents received via email 0.5% Active Vero or any other suitable provider At least 12-month review in person Product documents presented and discussed with by the Adviser in person 0.7% Active Plus Vero or any other suitable provider At least 6-month review in person Product review, documents presented and discussed with the Adviser in person 1% *Ongoing charge is based on the initial value of your investment. This can increase or decrease in line with your investment. I understand that the fee for this service is based on % of the value of the plan each year. I agree that the cost of the ongoing Client Support Strategy to be paid by (please tick relevant box): A deduction from the policies held (recommended) Being paid directly by me on a monthly/quarterly/yearly basis In signing this Client Support Agreement, I confirm that the changes have been fully explained to me. I understand that I can cancel this support facility at any time by contacting Truly Independent Ltd or the plan provider, at no extra cost. Client Name .......................................................................................................................................................................................... Signed .......................................................................................................................................................................................... Date ..........................................................................................................................................................................................
Business Type. Check all that apply. Minority Owned ☐ Disability Owned ☐ Veteran Owned ☐ Small Business ☐ Woman Owned ☐
Business Type. Sole Proprietor LLC Partnership S Corporation C Corporation Non‐Profit Other: Number of Benefit Eligible Employees: (Required) COMPANY’S FINANCIAL INSTITUTION INFORMATION Financial Institution Name (Required): Note: Your bank information will be verified with your financial institution enabling the transfer of funds. Phone: ACH Routing Number: Account Number: Account Type: Checking Savings DAILY LIMIT The daily limit is the total amount an employer can contribute through GOC on a given day. All daily contribution limits are subject to HSA Bank’s approval. Requested Daily Limit: EMPLOYER CHECKLIST Have you: Filled out this form completely Signed the form Signed the ACH Agreement Informed your external bank to allow debits from HSA Bank (ACH Company ID #: 1390634250)
Business Type. The Vendor Applicant shall be located at a fixed permanent location and shall furnish WIC foods to WIC customers only at the site of the authorized location. The Vendor shall be a grocery store with meat, produce, bread, cereals, and dairy goods. The vendor must be primarily a retailer of groceries with fifty (50) percent or more of its sales from groceries and not from any combination of alcohol, tobacco products, hot or cold prepared foods, or gas. Hawaii WIC does not authorize convenience stores (primarily engaged in retailing a limited line of goods that generally includes staple groceries such as milk, bread, soda, and snacks, non-foods, and ready-to-heat and ready-to-eat foods.) Convenience stores are usually between 500 to 5,000+ retail square feet, with 500 to 1,500 Stock Keeping Units (SKUs), with primary emphasis placed on providing the public a convenient location to quickly purchase from a wide array of consumable products and services. Convenience stores generally have 2 or less cash registers. Convenience stores usually carry a limited selection of grocery items and are not primarily serving families seeking a full line of groceries. In addition to not providing all the food needed by a family, convenience stores typically do not provide shopping carts and have limited parking. Convenience stores may be authorized only if a participant need has been determined, they meet all the criteria and there are no full line grocery stores within a ten (10) mile radius. The WIC Vendor may not derive, or be expected to derive, more than fifty (50) percent of their total annual food sales revenue from the sale of supplemental foods that are obtained with WIC purchases. WIC requires the total annual food sales data in order to determine, as required by law, whether a Vendor derives more than fifty
Business Type. Sole Proprietorship; Partnership; Corporation 1a. Operating Location: (check one) Commercial; Residential
Business Type. □ Sole Proprietor □ Partnership □ Corporation □ LLC □ Government □ Non-profit Business Description: Anticipated Credit Limit: $ Purchase Order Required? □Yes □No Job # Or Name Required ? □ Yes □ No Tax Exempt? □ Yes □ No
Business Type. We have agreed to allow you to accept the Sears Card based on the type of business you currently are in. In the future, if you elect to engage in any new lines or types of business activities, you must immediately inform us of this by contacting Citibank. If you fail to notify us, We may terminate acceptance of the Sears Card immediately and without further notice. There are some types of businesses We have determined We will not accept as Merchants. We may elect not to extend our Merchant acceptance to any new lines or business activities you might enter in to. Because of the irreparable damage to the value of the Sears Card and the Trademarks, the use of the Sears Card in connection with a going out of business sale, liquidation sale, insolvency or bankruptcy of Merchant is strictly prohibited. You agree that Citibank will be entitled to, and hereby consents to the entry without notice to your place of business or the posting of any bond in respect thereof by Citibank of, a stay, temporary injunction, and permanent injunctive relief prohibiting such use.
Business Type. 2.1. The Partners agree to work cooperatively and in unison for the purpose of carrying out the business of:
Business Type. (check all that apply) ❑ Grower ❑ Manufacturer ❑ Distributor ❑ Re-Wholesaler ❑ Broker ❑ Landscape Equipment 4 EXHIBIT SPACE RATES Member Non-Member Standard Booth (100 sq ft) $ 1,433.50 $ 1,785.00 Corner Booth (100 sq ft) $ 1,864.00 $ 2,320.50 Endcap Booth (200 sq ft) $ 3,440.73 $ 4,284.00 Island Booth (aisles on 4 sides) $ 1,577.00* $ 1,963.50* *Island booth prices are per 100 sq. ft. of space ❑ Other Equipment ❑ Business Services Contact Mailing Address Seedling Upgrade $ 500.00 $ 500.00 Budding Upgrade $ 750.00 $ 750.00 City, State, Zip Flowering Upgrade $1,000.00 $1,000.00 Contact Phone Contact Fax Contact Email Address Website Address
