Complete this Monthly Account Holder Agreement. Don’t forget to list your users in Section 2, select the services you wish to subscribe to, choose a billing method and sign below. Make sure you include your first year subscription fee of $100.00. 2) Complete any additional forms relevant to the services you select detailed in Section 2 and return them with this Agreement. This will only apply depending on the specific services you wish to subscribe to. 3) Sign and return this Agreement with your check or money order made out to the address above. Upon receipt of the signed and completed Agreement(s), West Virginia Interactive will activate your accounts to begin using your subscription services immediately. Please Note: some services may require additional approval as noted in Section 2 before access can be provided. CUSTOMER SIGNATURE – sign here By my signature I agree that: I have read and agree to the terms and conditions of West Virginia Interactive’s Monthly Account Holder Agreement as presented. If signing this Agreement on behalf of an organization or company, I represent that I have authority to bind the organization or company to this Agreement. Signature Date Name (printed) Title
Complete this Monthly Account Holder Agreement. Don’t forget to list your user in Section 2, select the services for which you wish to subscribe. 2) Complete any additional forms relevant to the services you select detailed in Section 2 and return them with this Agreement. This only applies if you subscribe to the specific services that require an additional form. 3) Sign and return this Agreement made out to the email above. Upon receipt of the signed and completed Agreement(s), Tyler Technologies (Xxxxx CT) will activate your account so you can begin using your subscription services immediately. CUSTOMER SIGNATURE – sign here By my signature I agree that I have read and agree to the terms and conditions of Tyler Technologies (Xxxxx CT) Monthly Account Holder Agreement as presented. If signing this Agreement on behalf of an organization or company, I represent that I have authority to bind the organization or company to this Agreement. Signature Date Name (printed) Title Section 2: Monthly Account Holder Information Physical Organization Name: Address Attention: Title: _ Address 1: Address 2: City/State/Zip: Telephone: Ext. Fax: Email Address: Billing Organization Name: Address Attention: Title: Address 1: Address 2: City/State/Zip: Telephone:
Complete this Monthly Account Holder Agreement. Don’t forget to list your users in Section 2 and initial the bottom of each page. 2) NICF will send account activation instructions to the primary account contact email address you have listed who is designated as the signer/administrator of the account. You may change the administrator after sign up is completed. BY SUBMITTING THIS AGREEMENT, YOU INDICATE THE ASSENT OF THE ORGANIZATION IDENTIFIED IN SECTION TWO (the "Monthly Account Holder") TO ALL OF THE TERMS AND CONDITIONS OF THIS AGREEMENT. IF THE PROSPECTIVE MONTHLY ACCOUNT HOLDER DOES NOT AGREE TO ALL OF THE TERMS AND CONDITIONS OF THIS AGREEMENT, DO NOT SUBMIT IT. 3) Upon receipt of the completed Agreement and accurate completion of the verification process, NICF will send usernames and passwords via email for the other users listed in the Agreement, to the email address you have listed for each of them. CUSTOMER SIGNATURE – Your submission of this application constitutes your signature to the Agreement on behalf of the Monthly Account Holder, and your express agreement with the items listed on the right hand side. Signature: Printed Name: Title: Date: By my submitting this application on behalf of the Monthly Account Holder (which constitutes the delivery of my signature on it) I agree that: 1. I have read and, on behalf of the Monthly Account Holder, agree to the terms and conditions of NICF’s Monthly Account Holder Agreement as presented. 2. I represent that I have authority to bind the Monthly Account Holder, on whose behalf I am signing, to this Agreement. 3. I have read and understand, and the Monthly Account Holder agrees to be bound by and comply with, the Limitations on Use of Information and the Fair Credit Reporting Act requirements listed under Section 3, #4 below. 4. The Monthly Account Holder will obtain and preserve the written disclosure and authorization of each Applicant prior to accessing the Applicant’s information on the PSP service, using the exact, stand-alone FMCSA-required document provided as part of this Agreement.
