Common Contracts
6 similar null contracts
EXHIBIT B PARTICIPATION FORMFebruary 6th, 2023
This is to request participation under the Group Purchasing Organization Laboratory Services Agreement dated January 1, 2023, between Healthcare Procurement Solutions, LLC (“CLIENT”) and Laboratory Corporation of America Holdings (“LABORATORY”).
Kitsap Community Resources Rental Assistance ProgramApril 27th, 2020
THIS SECTION IS TO BE COMPLETED BY THE TENANT Tenant name/personresponsible for rent: Tenant address Tenant phone # ( ) Please list the people whoare OR will live in the unit: Is the tenant receiving any other rental assistance from another organization? No YesIf yes please describe: THIS SECTION IS TO BE COMPLETED BY THE LANDLORD Is this a subsidized unit? Section 8 Tax credit unit? Public Housing Are you a private landlord? Yes No: please describe: Will the tenant do work exchange for part of the rent? No Yes:**If yes, portion of rent worked for is $ ** Are there any utilities included in the rent? No Yes:Please list which utilities: How long has the tenant lived in this rental unit? N/A Months Years Do you understand the rental assistance program, the length of time, and the client’s responsibility? Yes No Do you understand that we will issue you a promissory note about payment and it takes our administration office up to 15 days to issue payment? Yes NoIf no, please call the
To: From: Re:February 25th, 2020
Electronic Funds Transfer (EFT) Authorization AgreementMay 22nd, 2019
Medicaid Providers must submit this form to receive payment directly into their bank account. The funds can be credited to either a checking or savings account.
Amateur Trapshooting Association 2023 US Open/Grand AmericanOctober 24th, 2018
All workers of the group must be at least age 16 and attend one of the mandatory training sessions. If a worker is unable to attend a training session, they will be trained the first day they report to work. Please list all group workers on page 2.
NON BUSINESS VENDOR PROFILE FORMAugust 7th, 2013
