com. Your paper EOBs wi stop 31 days after the effective date of the ERA set up. f you woud ike your paper EOBs stopped on the effective date of the ERA/EFT set up pease check here. f you prefer not to aggregate by TN or NP and are not enroing the entire Tax D pease seect an aternative setup: Spit by Biing Address – Enro ony certain Billing Locations under the Tax D for EFT payments. List the appicabe Biing Locations to enro for EFT payment. Submit only one form per FAX. Faxes containing multiple forms will be returned. Fax the completed form, voided check and/or bank letter to: 000-000-0000 for new ERA/EFT enrollments and requests to change your ERA clearinghouse. o To check the status of an ERA enrollment, call 000-000-0000 000-000-0000 for EFT changes and ERA/EFT termination requests. o To check the status of an EFT change, call 000-000-0000 Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies. (Aetna) Definitions Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) PROVIDER INFORMATION Provider Name (Provider Address) Street City State/Province ZIP Code/Postal Code Complete legal name of institution, corporate entity, practice or individual provider The number and street name where a person or organization can be found City associated with provider address field ISO 3166-2 Two Character Code associated with the State/Province/Region of the applicable Country System of postal-zone codes (ZIP stands for "Zone Improvement Plan") introduced in the U.S. in 1963 to improve mail delivery and exploit electronic reading and sorting capabilities PROVIDER IDENTIFIERS INFORMATION Provider Identifiers Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN) National Provider Identifier (NPI) (Other Identifiers) Assigning Authority Trading Partner ID Enter TIN and NPI information A Federal Tax Identification Number, also known as an Employer Identification Number (EIN), is used to identify a business entity A Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered healthcare providers. Covered healthcare providers and all health plans and healthcare clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This mea...
com. If you have any questions about this Privacy Statement, txx xxxxxxxes of this site, or your dealings with this Web site, click here to contact us. Vstore.com is authorized by TRUSTe, the leading privacy seal program. XXXXXx xx an independent organization dedicated to building consumer trust and confidence in the Internet. The TRUSTe seal is currently displayed on all of the Internet's portal sites, 15 of the top 20 sites and approximately half of the top 100 sites. Since the summer of 1999, Nielsen/NetRatings has continuously rated TRUSTe as the most visible xxxxxx on the Internet.
com. A Settlement has been reached in a class action lawsuit against Whirlpool Corporation (“Whirlpool”), regarding KitchenAid-brand dishwashers manufactured by Whirlpool between October 2010 and the present. If you are included in the Settlement, you may qualify for benefits including a cash reimbursement of repair expenses, cash payments ranging from $15 to $90, free repairs, or rebates ranging from 10% to 30% on the purchase price of certain new KitchenAid-brand kitchen appliances. Your legal rights are affected whether you act or not. Read this notice carefully. YOUR LEGAL RIGHTS AND OPTIONS IN THIS SETTLEMENT SUBMIT A CLAIM FORM Earliest Deadline: [DATE] This is the only way to obtain benefits under the Settlement. EXCLUDE YOURSELF Deadline: [DATE] This is the only option that allows you to ever be part of another lawsuit against Whirlpool about the legal claims resolved by this Settlement. If you exclude yourself from this Settlement, you will not be able to get benefits from it. OBJECT Deadline: [DATE] This is the only way to tell the Court that you do not like something about the Settlement. ATTEND THE HEARING ______ at ____ This is your opportunity to ask to speak in the Court about the fairness of the Settlement. DO NOTHING If you do nothing, you will not receive benefits under the Settlement, and you will give up your right to ever be part of another lawsuit against Whirlpool about the legal claims resolved by this Settlement. These rights and options are explained in this Notice. The Court in charge of this case still has to decide whether to approve the Settlement. Benefits will be issued if the Court approves the Settlement and after any appeals are resolved. Please be patient. QUESTIONS? CALL 1-XXX-XXX-XXXX OR GO TO WWW _.COM BASIC INFORMATION
com. The Court in charge of this case still has to decide whether to approve the Settlement. If the Court denies final approval, the Settlement will be null and void and the litigation will continue with the Defendant. What This Notice Contains Basic Information page 3
com. You may also call 1- - - , or write to Xxxxx et al. v. LendingTree, LLC Settlement Administrator, P.O. Box , City, ST - . Please do not call the Court or the Clerk of the Court for additional information. They cannot answer any questions regarding the Settlement or the Action. — EXHIBIT C — CLAIM FORM Xxxxx, et al. v. LendingTree, LLC, No. 3:22-cv-00307 The DEADLINE to submit or mail this Claim Form is: [MONTH , 2023] GENERAL INSTRUCTIONS If your Private Information (name, address, Social Security number, date of birth, address, and additional personally identifiable information) was compromised or potentially compromised in the Data Security Incident, you are a “Settlement Class Member.” If you received a notice about this class action Settlement addressed to you, then the Settlement Administrator has already determined that you are a Settlement Class Member. As a Settlement Class Member, you are eligible to receive your choice of (1) three years of credit monitoring services, compensation for unreimbursed economic losses, and compensation for lost time, or (2) a cash payment. CLAIMANT INFORMATION The Settlement Administrator will use this information for all communications regarding this Claim Form and the Settlement. If this information changes before the Settlement benefits are issued, you must notify the Settlement Administrator. First Name M.I. Last Name Alternative Name(s) Mailing Address, Line 1: Street Address/P.O. Box Mailing Address, Line 2: City: State: Zip Code: - - - - Telephone Number (Home) Telephone Number (Mobile) Email Address (Required for Credit Monitoring Services) Date of Birth (mm/dd/yyyy) Claim Number Provided on mailed Notice (if known) / / BENEFIT SELECTION You may select Credit Monitoring and Compensation for Lost Time and Compensation for Unreimbursed Economic Losses OR a Cash Payment.
com. By: ------------------------------- Name: ----------------------------- Title: ---------------------------- LAURUS MASTER FUND, LTD. By: ------------------------------- Name: ----------------------------- Title: ---------------------------- Address for Notices:
com. COMPANY BACKGROUND Compaq Computer Corporation, the world's largest computer manufacturer, is a Fortune Global 200 company and the largest global supplier of personal computers. Founded in 1982, Compaq develops and markets hardware, software, solutions and services, including industry-leading enterprise computing solutions, fault-tolerant business-critical solutions, networking and communications products, commercial desktop and portable products and consumer PCS. The company is a leader in environmentally friendly programs and business practices. Compaq products are sold and supported in more than 100 countries through a network of authorized Compaq marketing partners. Customer support and information about Compaq and its products are available at http://www.compaq.com --------------------- or by calling 1-800-OK-COMPAQ. Product information and reseller locations are available by calling 1-800-345-1518.
com. Ligand and Royalty Pharma disclaim any intent or oxxxxxxxxx xx xpdate these forward-looking statements beyond the date of this release. This caution is made under the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. # # #
com. (a) Find/SVP covenants and agrees that:
com. During the Term of this Agreement, TSA.com agrees to NOT enxxxx xx the sale of goods over the Internet xx x xxareholder, partner or investor in any corporation, partnership, limited liability company or other entity or venture which directly or indirectly generates in excess of 20% of its revenues from the sale of sporting goods, athletic footwear, athletic apparel and related goods and services.
