RegistrationRegistration • February 12th, 2019 • Illinois
Membership Agreement New Renewal RewriteRegistration • February 1st, 2013
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of sex or marital status. The agency that administers compliance with the law is the Federal Trade Commission, Equal Credit Opportunity, Washington, D.C. 20580.
REGISTRATIONRegistration • October 27th, 2021
and assign directly to John Carlucci, D.C. all medical benefits, if any, otherwise payable to me for services rendered. I understand that I am financially responsible for all charges whether or not paid by insurance. I hereby authorize the doctor to release all information necessary to secure the payment of benefits. I authorize the use of this signature on all my insurance submissions.
Please read agreement on both sides before you registerRegistration • May 25th, 2012
