Cardholder Signature definition

Cardholder Signature. Budget Supervisor Signature: Date: PCard Administrator's Signature: Date: Date: Request for a PCard (Purchasing Card) Date: (mm‐dd‐yyyy) Cardholder Name: SPC Employee #: Department Name: Campus Location: Phone: Cell Phone: (for fraud alert notification) E‐mail address:

Cardholder Signature. Date: For Program Use only Limit Per Purchases: $ (Not to exceed $1000.00) Cycle Limit: $ (Not to exceed without authorization) Approval Signature: Date:

Cardholder Signature. Date: Cardholder Name (Print): Department: College/Division:

Examples of Cardholder Signature in a sentence

• Date Name of Cardholder Signature Final invoicing will be sent by our tour operator, Odysseys Unlimited, Inc.

• Cardholder Name (Print): Cardholder Signature: Date: I hereby acknowledge that in the event any amounts owed are not timely paid by the credit card company listed above, I will directly pay such amounts upon notice from the Club.

• Date: / MM YY 3-digit CVV(On the back of your card) Cardholder Name: Cardholder Signature: Total amount charged: The Park District reserves the right to change a payment to reflect the correct fee.

• Option 1: Automated Credit Card Charge Card Type: Visa Mastercard Amex Discover Cardholder Name: Credit Card Number: Expiration Date: / Cardholder Signature: I authorize Operator to automatically charge my credit card on a recurring basis to pay any sums due from me for parking charges payable under my Agreement for Monthly Parking Privileges.

• GSDO officials are analyzing risk factors and historical delays in the analysis to better estimate overall impact.

• The Sponsor/ExhibitorBilling Address City State Zip Cardholder Signature Dateagrees that upon receiving this application and sales contract by Syllabusx, with or without appropriate payment, thisMM DDYYYYapplication and sales contract shall CHECK is enclosed payable to SyllabusX.

• Cardholder Signature: ..................................................................................

• Date: V-Code: Cardholder Signature: For questions call (225) 387-3282 or e-mail laurent@lba.org.

• Credit Card #: - - - Exp Date: / Cardholder Name: Cardholder Signature: Please sign waiver below.

• Payment: ❑ Cash ❑ Check ❑ Credit Card (Visa, MC, Discover, Amex) Total Amount Enclosed Card # Cardholder Signature Exp.

More Definitions of Cardholder Signature

Cardholder Signature. Date: Cardholder Name (Print): Department/College/Division: I have received the above-mentioned P-Card. UHCL P-Card Administrator Signature: Date: P-Card Administrator Name (Print): Xxxxxx Xxxxxxx

Cardholder Signature. Date: Cardholder Printed Name:

Cardholder Signature. Date: Cardholder Name (Print): Department: College/Division: Parking and Transportation Office Signature:

Cardholder Signature. Expiration: CVV: Billing Zip: VHP8301 X Xxxxxxxx Xxxxxx, Xxxxx 000 Xxxxxxxxx Xxxxxxx, XX 00000-0000 Phone: (000) 000-0000 : Fax (000) 000-0000 NEW PATIENT INTAKE FORM (Private Pays or Self-Pays) PATIENT INFORMATION First Name: Last Name: Date of Birth: Gender: M [ ] F [ ] Weight (lbs.): Height: Dental Office Name: Contact Number: Dental Office Address: _ Primary Physician Name: (If applicable) Specialist Physician Name: Contact Number: Contact Number: PARENT OR LEGAL GUARDIAN INFORMATION Please check one. Mother [ ] Father [ ] Legal Guardian [ ] Other: Full Name: Date of Birth: Contact Number: Street Address: City: State: Zip: Email Address: PREGNANCY/NEONATAL HISTORY