Payment Agreement. The agreement between you and Barracudas begins at the point where a payment is made, whether in part or full, and is when these booking conditions apply from. This agreement is with you, as the person who made the booking, and you are responsible for ensuring any parent/carer relating to this booking are aware of, and accept, these booking conditions.
Payment Agreement. The Landowner hereby agrees to repay the Assessment Amount according to the Repayment Schedule attached hereto as Exhibit B, with annual payment coupons provided by the County Treasurer. It is generally the intent of the parties that the Landowner will repay the Assessment Amount over the course of five years with an interest rate of five percent (5%) with said payment to be made in two, semi-annual installments each year. Payments will be applied first to interest and then to the outstanding Assessment Amount. This section is an express covenant within the meaning of IC 32-29-1-2 acknowledging that, in addition to the mortgage created by this agreement, Landowner will also be personally liable for repayment as described herein. If more than one Landowner has signed this Agreement, Landowner obligations are joint and several. County may proceed against any, all or, none of the Landowners at its discretion, in order to enforce its rights under this Agreement. Absent a written agreement to the contrary, transfer of the Real Estate securing this Payment Agreement shall not relieve Landowner of Landowner’s obligations under this Agreement.
Payment Agreement. If the Borrower does not have an Account with any Federal Reserve Bank, the Borrower hereby agrees to the provisions of the Correspondent Credit and Payment Agreement, currently an ancillary agreement appended to the Circular (Exhibit 1 to the Circular’s Appendix 5), and designates ________________________________________ (Name of Agent/Correspondent) as “Correspondent” under that agreement. Authorized Individuals: The following individuals are permitted to provide instructions, pledge PPPLF Collateral to and request Advances from the Reserve Bank under the PPPLF on behalf of the Borrower. Name Title, Telephone and Email A Borrower that has not previously established access to the Discount Window by executing a standard Letter of Agreement to the Circular must enclose with this PPPLF Letter of Agreement a certified copy of the Authorizing Resolutions for Borrowers containing the titles of those persons authorized to request Advances from and to pledge PPPLF Collateral under the PPPLF. Notices: Any notices required under the PPPLF Agreement shall be directed as follows: If to the Borrower: If to the Reserve Bank: List department(s) and address(es) List department(s) and address(es) _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ Executed this ___ day of ______, 2020. _____________________________________________ Full Legal Name of Borrower By: _________________________________________ Signature(s) of individual(s) authorized to sign documents on behalf of the Borrower as provided in the Authorizing Resolution1 ______________________________________________ Name(s) ______________________________________________ Title(s) ______________________________________________ Telephone ______________________________________________ E-mail ______________________________________________ Routing Transit Number (RTN) of Borrower For Correspondents for Borrowers who do not have an Account with a Federal Reserve Bank: For th...
Payment Agreement. I understand and agree that payment is due at the time services are rendered and that health, dental and accident insurance policies are an arrangement between my insurance carrier and myself. I understand that this office will prepare any necessary dental reports and dental forms to assist me in making collection from my insurance company, and that any amount authorized to be paid directly to this office will be credited to my account on receipt. However, I clearly understand and agree that all services rendered to me are charged directly to me and that I am personally responsible for payment, regardless of insurance. If the patient is a minor, I am the parent and/or guardian of said patient and agree that I am responsible for all services rendered to the patient herein. I understand that if I suspend or terminate any care and treatment to me or any person referred to in the previous sentence any fees for professional services rendered will be immediately due and payable. Signature: (If Patient is a minor, Parent or Guardian must sign here and complete section below) Date: RESPONSIBLE PARTY Sex: M or F SIN DOB Street _( City ) Province ( ) Postal Code (Dr/Mr/Mrs/Miss) First Middle Last Jr/Sr Home Phone Work Phone Employer METHOD OF PAYMENT How will you pay for today’s visit? Cash Bank Check MasterCard Visa Card Other Charge Card Authorization By signing hereunder, I authorize Lakeside Dental to bill my charge card account should any balance for services rendered that remain outstanding for more than (60) sixty days. If the account information given expires or is otherwise discontinued, I agree to give Lakeside Dental information as to an alternate charge account, which may be used. My account is as follows: Visa MasterCard Interac Card # Exp Date Signature Date PATIENT CONSENT FORM FOR COLLECTION, USE AND DISCLOSURE OF PERSONAL INFORMATION Privacy of your personal information is an important part of our office, just as providing you with quality dental care. We understand the importance of protecting your personal information and we are committed to collecting, using and disclosing your personal information responsibly. We also try to be as open and as transparent as possible about the way we handle your personal information. It is VERY important to us to provide this service to all of our patients. In this dental office, the dental centre manager acts as the privacy information officer. All team members who have come in contact with your personal informa...
Payment Agreement. LESSEE further agrees to pay to the City on demand any and all sums, which may be due to the City for all required fees listed in this Lease Agreement, amenities/services listed in attachments, and special accommodations or materials as may be requested by LESSEE and approved by the City. All dues must be paid by a check, cash, money order or cashier’s check. Credit cards (only Visa and Master Card) are accepted only at our City Hall location.
Payment Agreement. [Reference No. insert reference number, if any; if none, delete bracketed text]
Payment Agreement. 1. As a courtesy to our clients, HCCC submits charges to contracted insurance plans. We are obligated to collect client responsibility amounts such as co-payment, co-insurance, deductible, and any non-covered services at the time of service. Sometimes, exact coverage cannot be determined until the insurance company receives the claim. Any overpayment will be applied as a credit to my account. If you prefer a refund, please contact the billing department for that request and to confirm mailing address to issue the refund.
Payment Agreement. Agreement between the City of New York, Department of Finance (DOF) and (Respondent/Payor) for Payment of Certain Environmental Control Board Violation(s) (Insert Respondent/Payor Name) Date: (Insert Date) OATH ID: (Insert OATH ID) Case #: PAYMENT AGREEMENT This Agreement is between the City of New York Department of Finance (DOF) and the person or entity against whom the judgments have been docketed by the New York City Office of Administrative Trials and Hearings Environmental Control Board (OATH ECB), hereinafter “Respondent” or the person or entity who is not the Respondent but is making the payment on the judgments that have been docketed against the above- mentioned Respondent by OATH ECB, hereinafter “Payor.” DOF and Respondent/Xxxxx and their respective successors and assigns, agree as follows:
Payment Agreement. (a) The Obligor, as primary obligor and not as surety, hereby agrees to fully and promptly pay to each Beneficiary the Guaranteed Amount when due to such Beneficiary under the applicable AWA Operative Document, but subject always to the provisions of Section 2.6. The foregoing payment obligation is made without prejudice to any right the Obligor may have to reject any AWA Operative Document in connection with any proceeding under Chapter 11 of the Bankruptcy Code in which the Obligor is a debtor; provided, however, that the Guaranteed Amounts include all amounts (including under Section 506(b) of the Bankruptcy Code) which would become due but for the operation of the automatic stay under Section 362(a) of the Bankruptcy Code, and the operation of Section 502(b)(2) of the Bankruptcy Code.
Payment Agreement. Winterthur and XL hereby agree that:
