NSF FEE. If any payment tendered by you is returned due to insufficient funds, you agree to immediately pay a fee of $50.00 in addition to any other fees we have incurred. Failure to pay this fee immediately shall be a material default and breach of this Agreement. If unpaid, the fee will be deducted from the security deposit at the termination of this Agreement.
NSF FEE. If any check tendered by Tenant is returned due to insufficient funds, the Tenant shall pay a fee of FIFTY DOLLARS ($50.00). This amount, if unpaid, may be deducted by Lessor’s Agent from the deposited amount pursuant to Paragraph #12 herein.
NSF FEE. If you present any type of payment instrument or method that is dishonored for any reason by the drawee, we may charge you a $10 fee in MA and a $25 collection fee in RI if you do not pay the face amount of the check or payment instrument within 30 days after written notice.
NSF FEE. If any check is dishonored for any reason, said late charges shall be due and payable in addition to a return check charge identified in the attached as an NSF Fee.
NSF FEE. You agree we may charge you a service charge for handling any dishonored payment instrument in the amount of $15 in Mississippi and Missouri, the greater of $20 or the bank fee in Florida; $25 in Kentucky and North Carolina; $30 in Alabama, Georgia (after notice) and Tennessee. If allowed by law, we may xxxx you for a $30 service charge in South Carolina after notice of dishonor.
NSF FEE. All payment returned due to non-sufficient funds will be subject to a NSF fee of $25.00 Thank you for understanding and accepting our Financial Policy. Please let us know if you have any questions or concerns. Patient or Guardian Signature Date Notice of information and Privacy Practices HIPAA Communication Form Patient Name: DOB: I have been given a copy of Professional Dental Alliance practice (“Practice”), Notice of Information and Privacy Practices (“Notice”), which describes how my health information is used and shared. I understand that the Practice has the right to change this Notice at any time. I may obtain a current copy by contacting the Privacy Officer at (000) 000-0000, or by visiting the Practice’s web site. Patient privacy is important to us. Our policy to keep patient health information confidential and not disclose such information without your consent or written authorization unless otherwise required by federal or state privacy laws. Please provide us with information with whom we can communicate with concerning your care. We would also like to obtain information regarding alternative communication preferences so that we know the best way to contact you with appointment reminders or other information related to your care. Please note: If you have someone accompany you in the treatment area, we will assume this person is entitled to receive information regarding your care and we can freely discuss your health information. You are free to make changes to your preferences at any time. Updates must be made in person and a new form completed. Please provide the names and relationship to patient for those individuals you will need or want your health information to be provided. This includes family members, friends, organizations or caregivers/babysitters: Name: Relationship: Name: Relationship: Name: Relationship: Name: Relationship: Patient Communication – Our practice is to protect the privacy of our patients while ensuring our patients are kept well informed of their appointments and other information. As a service to our patients, we will communicate appointment reminders and other information via text message, email or via phone. Limited information will be left when leaving a voice massage. Medical information will not be shared when leaving a voice message. Please inform our team if you would prefer we use an additional communication preference for appointment reminders or other information related to your care.
NSF FEE. If you present any type of payment instrument or method that is dishonored by the drawee, we may charge you a fee of $15 in CA, $20 in UT, $25 in CO, LA, NV, NM & OK, $30 in TX, AR (after notice) & HI(after notice), and the greater of $10 or bank fee in AZ.
NSF FEE. If you present any type of payment instrument or method that is dishonored by the drawee, we may charge you a fee of $15 in Wisconsin and $25 in Illinois, Indiana, and Michigan.
NSF FEE. The school reserves the right to refer accounts 30 days past due to collection, in which event you will also be responsible to pay any applicable collections costs and/or attorney fees otherwise incurred by the school. Students with past due accounts may be subject to Suspension or Recommended Transfer unless a written arrangement concerning the payment of the past due amount(s) is otherwise agreed to by the Xxxxxx Memorial Business Office. All tuition and fees for Senior students must be paid in full by May 1, 2019 in order for the student to participate in Baccalaureate/Graduation exercises. Other Payment Information: • All students must pay a non-refundable Registration/Activity Fee of $425 by June 1, 2018. • A non-refundable International Fee of $1,500 per student is due by June 1, 2018. • A non-refundable Technology Fee of $250 per student is due by June 1, 2018. • Payments may be made by cash, check, Electronic Fund Transfer, or credit card (Visa, Master Card, or Discover Card). On-line payments may be made through the Xxxxxx Memorial website at xxx.xxxxxx.xxx. For EFT payments, contact the Business Office. • Additional fees may be charged for certain activities including Athletics, Band, Classroom Materials, and Student Retreats. These fees will be billed to you when applicable and are due upon receipt. • iPad User Agreement: All students are issued an iPad for their academic use. All students and their parents/guardians must sign a new iPad User Agreement each year. All provisions of the iPad User Agreement are considered a part of this contract. Incoming/transfer students are required to purchase an iPad case from Xxxxxx Memorial High school at a cost of $40. • This Contract must be returned to the Business Office by June 1, 2018. No student will be allowed to begin the academic year without a completed Contract on file.
NSF FEE. We may collect this fee plus the original amount of the EFT or credit card charge electronically through a third party. o Your membership will be cancelled by the YMCA with no advance notice if returned dues are not collected within 30 days or if ANY draft is returned ACCOUNT CLOSED or INVALID ACCOUNT NUMBER.
