Office Telephone Number Insert the employee's area code, office telephone number and extension.
Home Telephone Number Employee's area code, home telephone number.
Vendor Telephone Number Self explanatory. (Agency specific) 1d. Vendor E-mail Address - Self explanatory. (Agency specific) 2a. Course Title - Insert the title of the course or the program that the employee is scheduled to complete.
Telephone Number Consumer Credit Associates, Inc. Call (000) 000-0000, either extension 000 Xxxxxxxxxxxx Xxxxxx, Xxxxx 000 150, 101, or 112, for all inquiries. Xxxxxxx, Xxxxx 00000-0000 Equifax Members that have an account number may call their local sales representative for all inquiries; lenders that need to set up an account should call (000) 000-0000 and select the customer assistance option. TRW Information Systems & Services Call (000) 000-0000 for all inquiries, 000 XXX Xxxxxxx current members should select option 3; Xxxxx, Xxxxx 00000 lenders that need to set up an account should select Option 4. Trans Union Corporation Call (000) 000-0000 to get the name of 555 West Xxxxx the local bureau to contact about setting Xxxxxxx, Xxxxxxxx 00000 up an account or obtaining other information.
Address for Notices Any notice to be given to the Company under the terms of this Agreement will be addressed to the Company, in care of its General Counsel, at 0000 Xxxxxx Xxxx, Xxxxxxxxxx, XX 00000, or at such other address as the Company may hereafter designate in writing.
Phone Number Email address .................................................................
Toll-Free Telephone Number A contractor located outside of San Francisco is encouraged to provide free telephone services for placing orders. This requirement can be met by providing a toll-free telephone number or accepting collect calls. The free service will be a consideration in evaluating this bid.
Address for Notice By:__________________________________________ Name: Title: With a copy to (which shall not constitute notice): Fax: [PURCHASER SIGNATURE PAGES TO MDGS SECURITIES PURCHASE AGREEMENT] IN WITNESS WHEREOF, the undersigned have caused this Securities Purchase Agreement to be duly executed by their respective authorized signatories as of the date first indicated above. Name of Purchaser: ________________________________________________________ Signature of Authorized Signatory of Purchaser: __________________________________ Name of Authorized Signatory: ____________________________________________________ Title of Authorized Signatory: _____________________________________________________ Email Address of Authorized Signatory: ______________________________________________ Facsimile Number of Authorized Signatory: _____________________________________________ Address for Notice to Purchaser: Address for Delivery of Securities to Purchaser (if not same as address for notice): Subscription Amount: $_________________ Shares: _________________ Warrant Shares: __________________ EIN Number: _______________________ [SIGNATURE PAGES CONTINUE] DISCLOSURE SCHEDULES These Disclosure Schedules are delivered to you pursuant to Article III of that certain Securities Purchase Agreement (this “Agreement”) dated as of June __, 2014, between Medigus Ltd., an Israeli company (the “Company”), and each purchaser identified on the signature pages thereto (each, including its successors and assigns, a “Purchaser” and collectively, the “Purchasers”). Unless otherwise defined herein, any capitalized term used in a Disclosure Schedule shall have the same meaning assigned to such term in the Agreement. The following disclosures are an integral part of the Agreement. These Disclosure Schedules are qualified in their entirety by reference to specific provisions of the Agreement, and are not intended to constitute, and shall not be construed as constituting, representations or warranties of the Company except and to the extent provided in the Agreement. The inclusion of any item in any Disclosure Schedule shall not be deemed to be an admission by the Company that such item is material to the business, assets (including intangible assets), liabilities, capitalization, financial condition or results of operations of the Company or its operations and is not an admission of any obligation or liability to any third party. No disclosure in a Disclosure Schedule relating to any possible breach or violation of any agreement, law or regulation shall be construed as an admission or indication that any such breach or violation exists or has actually occurred. Each Purchaser acknowledges and agrees that any matter disclosed pursuant to a section, subsection, paragraph or subparagraph of a Disclosure Schedule shall be deemed disclosed for all other purposes of the Disclosure Schedules as and to the extent the content or context of such disclosure makes it reasonably apparent on the face of such disclosure that such disclosure is applicable to such other section, subsection, paragraph or subparagraph of the Disclosure Schedules. Where the terms of a contract, lease, agreement or other disclosure item have been summarized or described in a Disclosure Schedule, such summary or description does not purport to be a complete statement of the material terms of such contract, lease, agreement or other disclosure item and such summaries are qualified in their entirety by the specific terms of such agreements or documents. Schedule 3.1(a) Subsidiaries
Website, Email Address and Toll-Free Number The Administrator will establish and maintain and use an internet website to post information of interest to Class Members including the date, time and location for the Final Approval Hearing and copies of the Settlement Agreement, Motion for Preliminary Approval, the Preliminary Approval, the Class Notice, the Motion for Final Approval, the Motion for Class Counsel Fees Payment, Class Counsel Litigation Expenses Payment and Class Representative Service Payment, the Final Approval and the Judgment. The Administrator will also maintain and monitor an email address and a toll-free telephone number to receive Class Member calls, faxes and emails.
Telephone Numbers Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh Valley, PA 18002-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.
