Mail to. Signature: _____________________ Pacific Stock Transfer Company Print Name: ____________________ 500 East Warm Springs Road, Suite 240 Las Vegas, Nevada 89118 ________________________________ ________________________________ Federal Employer Identification Number/Social Security Number ________________________________ Street Address ________________________________ City, State and Zip Code ________________________________ Telephone Number
Mail to. NC 529 Plan P.O. Box 40877 Raleigh, NC 27629-0877 That document should be read in full before completing this Enrollment and Participation Agreement for Entities (the “Enrollment Agreement”). Overnight or registered mail: NC 529 Plan 0000 Xxxxxxxxx Xxxx. Raleigh, NC 27604 This form must be completed by an Authorized Representative of the entity. A separate Enrollment Agreement must be completed for each Account. Note: This enrollment form establishes an Account for an entity; use form C420, Enrollment and Participation Agreement, to set up an Account as an individual Participant. 1 Please print clearly in capital letters and dark ink. Entity & Account Fax to: 000-000-0000 Email to: xxxxxxx@xxxx.xxx For questions or forms, contact the Program Administrator: College Foundation, Inc. XX000.xxx 000-000-0000 000-000-0000 (Raleigh) One of the College Foundation of North Carolina (CFNC) services helping students and families plan, apply and pay for college. I am establishing this Account as an Authorized Representative of the entity:
Mail to. Norwest Investment Management and Trust Corporate Trust and Escrow Services 1740 Broadway Denver, XX 00000-0000 Xxx xxx xx xxxxxxx xx xxxxxxor of a publicly held company? _______ Are you over 21 years of age? ______ Name of address of employer ________________________________________________ ____________________________________________________________________________ Occupation_______________________________ Individual income $______________ with spouse $_________ Net Worth $___________________ Investment objective: conservative ____ speculative ____ income____
Examples of Mail to in a sentence
Purchase Order Mail To Address City/State/Zip Phone# ( ) Fax# ( ) Email WebSite Payment Remittance Address if different: City/State/Zip Phone# ( ) Fax#( ) 1.
Complete the fields that display below the Service Address Information: Example: Pay To Address Example: Mail To Address ADDRESS SAME AS SERVICE LOCATION: If the addresses to be entered in this section are the same address as the Primary Service Location, click the “Same as Service Location” checkbox at the top of each Address type section.
Visit SDI Online (edd.ca.gov/SDI_Online) to get started.• Mail: To file a claim with the EDD by mail, complete and submit a Claim for Disability Insurance (DI) Benefits (DE 2501) form.
Date: / / Card Type:D VISAD MasterCardD AmEx Please take a moment to fill out the following about your stay on Alabama’s Gulf CoastArrival Date: / / Total No. of Nights of Your Stay: Total No. In Your Party: Name of Lodging Facility: Mail To: Bama Coast Cruisin’, 2107 N.
From the list below, locate the address of the board of canvassers in the city or town in which you are registering to vote and insert that address in the appropriate space beneath " Mail To: BOARD OF CANVASSERS" on the addressed side of the voter registration form.
More Definitions of Mail to
Mail to. Xxxx Xxxxxx, Planning & Development Services, Zoning Division, 0000 Xxxxxxxx Xxx, Xxxxx 000, Xxx Xxxxx, XX 00000. As soon as the INITIAL DEPOSIT monies, Public Notice Package, and PDS-346 have been received, PDS staff will then change the status of the project from “pre-intake” to “Intake.” Users can view the application information and status on-line. See PDS-318 for instructions. I, , acknowledge reading the EPAS Guidelines & Agreement Print Name ----- OFFICIAL USE ONLY ----- and understand a copy will be placed in my case file. My signature indicates that I understand and agree with its content and requirements. Customer Signature: Date: Email Address: 0000 XXXXXXXX XXX, XXXXX 000, XXX XXXXX, XX 00000 ● (000) 000-0000 ● (000) 000-0000 xxxx://xxx.xxxxxxxx.xx.xxx/pds
Mail to. North American Land Trust, PO Box 467, Chadds Ford, PA 19317; email to: xxxxxxx@XXXX.xxx.
Mail to. Signature: ___________________________ Spongetech Delivery Systems, Inc. Subscription Account Print Name: __________________________ c/o Continental Stock Transfer & Trust Co. ______________________________________ 00 Xxxxxxx Xxxxx, 0xx Xxxxx ______________________________________ Federal Employer Identification Number/ Xxx Xxxx, Xxx Xxxx 00000 Social Security Number -------------------------------------- Xxxxxx Xxxxxxx -------------------------------------- Xxxx, Xxxxx and Zip Code -------------------------------------- Telephone Number
Mail to. FAX To: Bureau of Managed Health Care Programs Bureau of Managed Health Care Programs ATTN: Birth Costs, Room 265 ATTN: Birth Costs X.X. Xxx 000 (608) 261-7792 Madison, WI 53701-0309 HMO Contract for February 1, 2006 - December 31, 2007 -199-
Mail to. Signature: ____________________________ Spongetech Delivery Systems, Inc. Print Name: ___________________________ Subscription Account c/o Continental Stock Transfer & Trust Co. _______________________________________ 2 Broadway _______________________________________ Federal Employer Identification Number/ Xxx Xxxx, Xxx Xxxx 00000 Social Security Number _______________________________________ Street Address _______________________________________ City, State and Zip Code
Mail to. Attn: : [company] : [street] : [City, State Zip] : : Loan #______ Commitment #_________ : ASSIGNMENT OF DEED OF TRUST FOR VALUE RECEIVED, NEW CENTURY MORTGAGE CORPORATION [or insert name of affiliate to which Agreement has been assigned , a California corporation, ("Assignor") does hereby grant, assign and transfer to ______________________, a ____________________, ("Assignee") all beneficial interest under that certain Deed of Trust ("Deed of Trust") dated ________________, 19____, executed by ________________________, Trustor, to ______________________, Trustee, and recorded _____________, 19____, as Instrument No. ________, or Book ________, Page ________, of Official Records in the Office of the County Recorder of ___________ County, ________, State of __________, affecting the real property therein described, TOGETHER with the note(s) therein described or referred to, the money due and to become due thereon with interest, and all rights accrued and to accrue under the Deed of Trust; without recourse on, or any warranty or representation whatsoever by Assignor. Any notices required or permitted to be given to the Assignee under or in connection with this Assignment or under or in connection with the Deed of Trust may be given at the following address: _________________________________ _________________________________ _________________________________ or such other address or addresses as may be stated in any document or instrument recorded hereafter referring to this Assignment and identifying the Deed of Trust so affected. Dated: _______________ NEW CENTURY MORTGAGE CORPORATION [or insert name of affiliate to which Agreement has been assigned] By: ____________________________ ____________________________ By: ____________________________ ____________________________ Attach appropriate form of notary acknowledgment. Exhibit E Seller's Wire Instructions -------------------------- [To be attached.]
Mail to. Email to: Michigan Department of Health and Human Services XxxxxxxxXxxxxxxxxx@xxxxxxxx.xxx Provider Enrollment Section PO Box 30238 Lansing, MI 48909 Fax: 000-000-0000 Reason for Submission (check all that apply) Revalidation New Tax ID/SSN (List Provider Enrollment staff contact name) Domain Access Other (List reason) Group Individual Both Domain Administrator Contact Information Contact Information (REQUIRED) Name Email Address Phone Number MILogin User ID Provider’s NPI Number Provider’s Date of Birth Provider’s Home Address Provider Enrollment Office Use Only Provided Domain Administrator contact information Sent/Gave to team lead for processing Sent to processor with W-9 attached Opened for revalidation AUTHORITY: 42 CFR 455.104 COMPLETION: Voluntary, but required for access to CHAMPS. The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs or disability. MDHHS-5405 (Rev. 12-18)