TENDER FORM AND AGREEMENTForm and Agreement • August 2nd, 2022
the Contractor, the Party of the First Part and The Government of Prince Edward Island as represented by the Honourable Cory Deagle, herein called the Minister, the Party of the Second Part.
DEPARTMENT OF TRANSPORTATION AND INFRASTRUCTUREForm and Agreement • October 5th, 2021
the Contractor, the Party of the First Part and The Government of Prince Edward Island as represented by the Honourable James Aylward, herein called the Minister, the Party of the Second Part.
Electronic Payment Authorization Form and AgreementForm and Agreement • November 22nd, 2020
This is an Agreement for electronic payments between Great Plains Medicare Advantage (“Payor”) and its applicable affiliate(s) and Name [ ],
DEPARTMENT OF TRANSPORTATION AND INFRASTRUCTUREForm and Agreement • April 20th, 2021
the Contractor, the Party of the First Part and The Government of Prince Edward Island as represented by the Minister of Transportation and Infrastructure, herein called the Minister, the Party of the Second Part.
DEPARTMENT OF TRANSPORTATION AND INFRASTRUCTUREForm and Agreement • May 24th, 2022
of the First Part and The Government of Prince Edward Island as represented by the Minister of Transportation and Infrastructure, herein called the Minister, the Party of the Second Part.
Take Care of Texas Kids Art ContestForm and Agreement • October 21st, 2020
Student Name Age Grade (K-5) Gender Parent/Guardian Phone Parent/Guardian Email County You Live In School Name School Phone School Address City Zip Principal Name Email Teacher Name Email
This is an Agreement for Electronic Funds Transfer (EFT) between NHC Advantage Plan Missouri (“Payor”) and itsForm and Agreement • August 2nd, 2021
.MUST SELECT ONE ☐ NEW AGREEMENT ☐ CHANGE ACCOUNT ☐ CANCEL NPI NUMBER: TAX ID NUMBER: PAYEE NAME: REMIT TO ADDRESS: NAME OF PAYEE’S CONTACT: TELEPHONE: E-MAIL: PAYEE’S BANK or DEPOSITORY INSTITUTION ACCOUNT INFORMATION (US Based Banks ONLY) ACCOUNT TYPE ☐ CHECKING ☐ SAVINGS EFFECTIVE DATE OF CHANGE: BANK/DEPOSITORY INSTITUTION NAME: BANK/DEPOSITORY INSTITUTIONADDRESS: TELEPHONE: FAX: E-MAIL: BANK CONTACT NAME: BANK/DEPOSITORY ACCOUNT NAME: BANK/DEPOSITORY INSTITUTION ACCOUNT NUMBER: ABA/ROUTING NUMBER (9 DIGITS): E-MAIL ADDRESSES OF ANYONE WHO NEEDS TO BE NOTIFIED OF PAYMENTS: The undersigned Payee hereby authorizes Payor to initiate credit entries and to credit on or after the effective date specified to Payee’s above account at the above Bank (and to any additional Bank accounts of the Payee identified on addenda attached here to) that the Payee has correctly identified by ABA (American Banking Association) routing and account numbers. If
ENROLMENT FORM AND AGREEMENT DOMESTIC STUDENTSForm and Agreement • May 6th, 2020
TAKE CARE OF TEXAS KIDS ART CONTESTForm and Agreement • October 30th, 2019
I, give permission to enter his/her artwork (“Artwork”) in the Take Care of Texas Kids Art Contest (“Contest”). I warrant and represent that my child and I have complied with the Official Contest and Design Rules. We understand the artwork must be submitted on 8.5”x11” paper and include the “Take Care of Texas. It’s the only one we’ve got.” slogan, and illustrate positive ways Texans can help keep our air and water clean, conserve water and energy, and reduce waste.
Fall / Winter Season 2020-21Form and Agreement • September 15th, 2020
Full Season Court Rates Days Time Price Monday-Friday 7AM-8AM $1320 8AM-9AM $1500 9AM-1PM $1795 1PM-3PM $1500 8PM-10PM $2460 10PM-12AM $1350 Friday Only 8PM-11PM $1440 Saturday/Sunday 7AM-8AM $1500 8AM-9AM $1650 9AM-3PM $2460
MEMBER FDICForm and Agreement • February 26th, 2014 • Hawaii
BUSINESS INFORMATION Full Legal Name of Business Taxpayer Identification Number (TIN) Business Mailing Address City State Zip Code Business Phone Cell Phone Email Address (All ASB notices will be sent to this email address and/or to the physical address on file) AUTHORIZED USER – Access is granted exclusively to the individual named below Name of individual Title Business Phone Business Email AGREEMENT
OPTION APPROVAL FORM AND AGREEMENTForm and Agreement • June 19th, 2013
This Agreement is intended to cover the respective rights and obligations of the Customer, GlobaLink Securities ("The Broker") and Wedbush Morgan Securities, (as margin lender and/or the Broker's clearing firm)("Wedbush Morgan"), in connection with puts and calls that may be handled, purchased and/or endorsed for the account of the Customer. In consideration of the Broker transacting such business, the Customer agrees as follows:
Client Intake Form And Agreement Dr Marilyn Life CoachForm and Agreement • November 7th, 2020
Client Intake Form and Agreement MARILYN GANSEL PSYD POSITIVE PERFORMANCE COACH amp BEHAVIOR CHANGE EXPERT FOR HEALTHY LIVING After your 40 minute STRATEGY session with me by phone or in person you may decide to use one or several of my services Once we decide what service s works best for you click here for the Client Intake Form and the Client Agreement both of which must be filled out signed and faxed or emailed back to me
Credit Form and AgreementForm and Agreement • October 19th, 2021
This Credit Application and Agreement shall relate to transactions with Frank Mastoloni & Sons, Inc. (‘Mastoloni’), its subsidiaries and divisions. Please complete the necessary information and return via fax or email at your earliest convenience.
Nexus 5001™ Membership Form and AgreementForm and Agreement • November 20th, 2012
Please complete and submit an original signed copy of this Membership Form and Agreement along with the appropriate membership fee to the IEEE‐ISTO. Membership rights and privileges will commence upon confirmation from the IEEE‐ISTO that the agreement and payment in full have been received. The Nexus5001™ Forum fiscal year is January 1 through December 31. New Members joining before July 1 shall pay the full annual fee for that year; new members joining on or after July 1 shall pay half of the full annual fee.
BIDV CREDIT CARD APPLICATION FORM AND AGREEMENTForm and Agreement • December 28th, 2018
Education Level* Secondary High School College University/Master/PhD Marital Status* Single Married Divorce Judicial Separation Others (please specify)
AGREEMENTForm and Agreement • April 10th, 2020
By signing below, I hereby acknowledge that I have read and understand the Manitoba Fish and Wildlife Enhancement Fund – Fisheries Enhancement Stamp Artwork Competition Rules for the current year in which the competition falls, and I agree to comply in all respects with these Competition Rules, including those applicable to the winning artist. Also by signing below, I declare that the artwork (both subject and background) is an original composition of my own creation. I grant the Manitoba Fish and Wildlife Enhancement Fund and/or Manitoba permission to use an image of my artwork, my name, my biography and any personal statement describing the artwork for posting on their respective websites and other promotional materials. I grant permission for my artwork to be displayed at any special exhibit sponsored by the Manitoba Fish and Wildlife Enhancement Fund and/or Manitoba.
BID FORM AND AGREEMENTForm and Agreement • February 10th, 2021
NOTE: Submit one copy of this Bid Form. All blanks shall be completed. Only bids on this form will be accepted. Submit bid security in separate envelope. This bid will remain subject to acceptance for thirty (30) days after the day of Bid opening.
ACTIVITY APPLICATION FORM and AGREEMENTForm and Agreement • October 8th, 2022
SHeffield Public art Recording Volunteer Application form and agreementForm and Agreement • March 31st, 2022
Please complete sections that are not marked with an asterisk if you consent to supply the information to help us understand our diversity profile (see below) but it is not mandatory for the agreement.
WTUN Exchange Programme 2021/22 Proposal Form and Agreement For staff members or PhD students from member institutions only.Form and Agreement • December 17th, 2019
Proposed Cost of the Exchange (GBP) Please note that the maximum grant amount available is 2000GBP. Any costs above this must be covered by the participants institution.
SPEAKER APPEARANCE REQUEST FORM AND AGREEMENTForm and Agreement • October 31st, 2023
For requests to schedule Dean Hulce for a speaking engagement, please complete this form. Submit by mailing the completed form along with $250 deposit payment to:
PLAYER INFORMATIONForm and Agreement • February 13th, 2020
First Name Last Name Date of Birth USTA Membership Number PARENT/GUARDIAN UTA Profile Number School and Grade Level First Name Last Name Email Address Street Address City State
JMP GROUP INC.Form and Agreement • February 5th, 2009 • JMP Group Inc. • Security brokers, dealers & flotation companies • California
You (the “Participant”) have been selected to participate in the JMP Group Inc. 2008 Compensation Program (the “Program”), subject to the terms and conditions of this election form and agreement (the “Election Form”) and the related agreement attached hereto setting forth the additional terms and conditions applicable to your participation in the Program (the “Participation Agreement”).
Unboxing Form and AgreementForm and Agreement • June 22nd, 2021
Fill out this form, print it and attach it to your products when you are sending products to us for promotion. Please read this document carefully and sign it. Keep one copy for yourself. Unsigned or missing Unboxing forms cannot be processed. Only sign this agreement if you have the authority to do so and if you fully agree with all the terms.
ContractForm and Agreement • January 24th, 2018
EMAIL AND INTERNET USAGE AUTHORISATION FORM AND AGREEMENT FOR CONTRACTORS AND GUESTSForm and Agreement • July 14th, 2021
MEMBER FDICForm and Agreement • February 26th, 2014 • Hawaii
BUSINESS INFORMATION Full Legal Name of Business Taxpayer Identification Number (TIN) Business Mailing Address City State Zip Code Business Phone Cell Phone Email Address (All ASB notices will be sent to this email address and/or to the physical address on file) AUTHORIZED USER – Access is granted exclusively to the individual named below Name of individual Title Business Phone Business Email AGREEMENT
PLAYER INFORMATIONForm and Agreement • February 13th, 2020
First Name Last Name Date of Birth USTA Membership Number PARENT/GUARDIAN UTA Profile Number School and Grade Level First Name Last Name Email Address Street Address City State
ContractForm and Agreement • October 5th, 2017
COMMUNITY BASED ORGANIZATION PROGRAM REFERRAL REGISTRATION FORM AND AGREEMENT (“CBO AGREEMENT”) * indicates required field*COMMUNITY BASED ORGANIZATION (“CBO”) NAME: *CONTACT NAME: *CONTACT NAME FOR PAYMENT PURPOSES: *MAILING ADDRESS: *PHONE NUMBER: *EMAIL ADDRESS: WEBSITE: BUSINESS LICENSE #: *FEDERAL EMP. ID#: NOTE: CBO’s current W-9 must be submitted to Allied Universal *NON-PROFIT ORGANIZATION OR TAX EXEMPT YES NO If YES, please provide either a valid and current tax exemption certificate or direct pay certificate, authorized by the appropriate taxing authority with this completed form. *INDICATE YOUR TYPE OF SPECIAL ENTERPRISE Not-Applicable Faith-Based Organization (FBO) African American Business Enterprise (AABE) Veteran owned business enterprise (VBE) Service Disabled Veteran Owned Small Business (SDVOSB) Minority business enterprise (MBE) Small business enterprise, (SBE) Women-owned business enterprise (WBE) Disabled veteran business enterprise (DVBE) Disadvant
PLAYER INFORMATIONForm and Agreement • September 15th, 2020
First Name Last Name Date of Birth USTA Membership Number PARENT/GUARDIAN UTA Profile Number School and Grade Level First Name Last Name Email Address Street Address City State
Electronic Payment Authorization Form and AgreementForm and Agreement • March 31st, 2020
This is an Agreement for electronic payments between Lifeworks Advantage or its applicable affiliate(s), individually and Name [ ], hereinafter referred to as “Payee”.
AUTHORIZED ONLINE MARKETPLACE RESELLER APPLICATION FORM AND AGREEMENTForm and Agreement • October 18th, 2020
Company/business legal name Trading as Registered address Name of Master Distributor Company/business registration number (as applicable) VAT number (as applicable) URL(s) of third-party marketplace/platform store(s) from which you intend to sell Nutraceutical Products Nutraceutical brands you intend to list for sale (enter one or more) Customer service line telephone number Customer service email address Contact person name and title/role Contact email address Contact telephone number
EQUIPMENT LOANS: RESERVATIONS FORM AND AGREEMENTForm and Agreement • April 13th, 2023
INSTRUCTIONS: Carefully read equipment loan procedures on reverse side of this form. Please read and sign agreement at bottom of this page.
HUSSAINI ASSOCIATION OF SASKATOONForm and Agreement • February 3rd, 2019
Name Address Phone # Cell Home Email Date/Time Requested Date From To Time From To Purpose of Use Do you want to serve Food: Y / N Space & Equipment Kitchen No. of Chairs Sound System No. of Tables
