Name: Address. City: County: State: Country: Tel. Number: Cell Number: Fax Number: Email:
Name: Address. American Land Lease, Inc. 00000 X.X. Xxx. 00 Xxxxx Xxxxxxxxxx, Xxxxxxx 00000 Customer is a (check one): Corporation x Partnership ¨ Individual/sole proprietor ¨ Trust ¨ Limited liability company ¨ Enter the tax classification (D=disregarded entity, C=Corporation, P=Partnership Other Taxpayer is (check if applicable): x Exempt from backup withholding Under the penalties of perjury, the undersigned certifies that:
Name: Address. Tax Identification Number: Physical Location of Notes (including address): Address: Contact:
Examples of Name: Address in a sentence
Vendor Name: Address: City: State:Zip: The undersigned being authorized to certify, hereby certifies that the submission provided herein represents compliance with the provisions of N.J.S.A. 19:44A-20.26 and as represented by the Instructions accompanying this form.
Name Title Company Name Address Signature Date EL PASO COUNTY PURCHASING DEPARTMENT 800 E.
Proposal Form of: (Firm Name) (Address, City, State, Zipcode)(For official use only) PAGE INTENTIONALLY LEFT BLANK The company, firm, corporation, or individual hereby acknowledges that it has designated a responsible person or persons as having the authority to obligate the company, firm, or individual, through electronic or paper submittal, to the terms and conditions described herein and in the contract documents.
Signature Printed Name Title Date Company Name Address Subscribed and sworn to before me by (Affiant) (Title) of this day of ,20 .
That Legislator is: Name: Address: City State Zip: Business Telephone:REQUIRED CONTRACT PROVISION- 04-26-90-R05 (Rev.
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Name: Address. Dated: ___________, ______. ________________________ (Name of Holder) (Social Security or Taxpayer Identification Number or Holder, if applicable) (Signature of Holder or Authorized Signatory) Signature of Guaranteed: Annex B to Common Stock Purchase Warrant FORM OF ASSIGNMENT ------------------ (To be executed upon transfer of Common Stock Purchase Warrant) FOR VALUE RECEIVED, the undersigned hereby sells, assigns and transfers to ___________________________ the right represented by the Common Stock Purchase Warrant to which this Form of Assignment applies, No. WA- ________, together with all rights, title and interest therein, and does hereby irrevocably constitute and appoint _________________________ attorney to transfer such Common Stock Purchase Warrant on the warrant register of __________________________, the issuer of the Common Stock Purchase Warrant, with full power of substitution. Dated: _____________, ______. Signature: (Signature must conform in all respects to name of holder as specified on the face of the Warrant) Signature Guaranteed:
Name: Address. City: State: Zip: Phone: ( ) Email: What kind of special event Date(s) of your event: Guest count: Estimated Budget: Your signature: To retain our service please include a check for $100 and mail to: The Crystal Lake Catering Co. 000 Xxxxx xxxxxx Frankfort MI 49628 Thank you for your interest in, and your patience in working with CLCC. Based upon our previous discussion, we feel confident that you and I can compose a mutually acceptable catering contract for your special event. We look forward to working with you to compose the contract as well as catering it on the date listed above. Please contact me if you have any questions and/or concerns. Regardless of what you decide to do, Congratulations!
Name: Address. Phone: Name: Address: Phone: Previous Fuel Provider: For How Long: Bank Information: Bank: Branch: City/State: Account #: Contact: Phone: Please Provide The Following Info For Partners/Officers/Owners: Name: Title: Home Phone: SSN: Home Address: City: State: Zip: Name: Title: Home Phone: SSN: Home Address: City: State: Zip: Leathers Fuels Card Holder Terms Account holder shall be responsible for all purchases made by account holder or by any other person using the Cardlock cards issued to the account holder, regardless of whether use by any other person is fraudulent or unauthorized or in violation of non-retail dispensing rules. Leathers Fuels will maintain the Cardlock system in good working order and condition at its own expense. Leathers Fuels will not be responsible for any damage of loss which may result from its failure to provide fuel or the failure of the Card- lock system in any manner whatsoever. Account holder agrees that it and any person using the Cardlock cards delivered to account holder shall promptly notify Leathers Fuels of any malfunctioning of the Cardlock system of which account holder becomes aware. StarOilco Credit Terms Cardlock holder xxxxxxxxnds that the terms of the sale are ten (10) net days from date of invoice, and the billing will be twice a month. A late charge of 1 and 1/2 percent (1.5%) per month will be assessed on the accounts that are past due. If this account is not paid as agreed and legal action, collection or suit proceedings are necessary, the cardholder agrees to pay all attorney’s fees and/or collection fees. Should legal action or suit become necessary, the undersigned will agree to venue in Multnomah County, State of Oregon. If there is any change in the ownership of the account holder, or if substantially all of the assets of the account holder are sold, account holder shall promptly notify StarOilco of said sale and StarOilco shall have a lien on all of the assets of the account holder, and a lien of proceeds. Oregon State Fire Marshall assessex xx xxxual fee which StarOilco is required to pay. StarOilco in turn will pass the fee onto our customers. This yearly fee is $5.00 per customer for October 1 through September 30. I CERTIFY THE STATEMENTS MADE ABOVE FOR THE PURPOSE OF OBTAINING CREDIT ARE TRUE AND I AUTHORIZE STAROILCO TO MAKE A CREDIT INVESTIGATION WHICH WILL INCLUDE CONSUMER AND COMMERCIAL CREDIT REPORTS. THIS IS A CONTINUOUS AUTHORIZATION. SIGNATURE: DATE: PRINTED NAME: TITLE: Guarantee Of Debt Th...
Name: Address. Attention: Telephone: Telecopy: Bank of America, N.A. 0000 XXX Xxxx. Xxxxx 0000 Xxxxxxxxxxxx, XX 00000 Xxxxxxx X. Xxxx (000) 000-0000 (000) 000-0000 $37,500,000.00 $12,500,000.00 $50,000,000.00 16.666667% Name: Address: Attention: Telephone: Telecopy: First Commonwealth Bank 000 Xxxxx Xxxxxx Xxxxx 0000 Xxxxxxxxxx, XX 00000 Xxxxx X. Xxxxxxx (000) 000-0000 (000) 000-0000 $22,500,000.00 $7,500,000.00 $30,000,000.00 10.0000000% Name: Address: Attention: Telephone: Telecopy: First National Bank of Pennsylvania 00 Xxxxxxx Xxxxxx Xxxxx 000 Xxxxxxxxxx, XX 00000 Xxxxx X. Xxxxx (000) 000-0000 (000) 000-0000 $22,500,000.00 $7,500,000.00 $30,000,000.00 10.0000000% Total $225,000,000.00 $75,000,000.00 $300,000,000.00 100% SCHEDULE 1.1(B) COMMITMENTS OF LENDERS AND ADDRESSES FOR NOTICES Part 2 - Addresses for Notices to Borrowers and Guarantors: ADMINISTRATIVE AGENT Name: PNC Bank, National Association Address: One PNC Plaza 000 Xxxxx Xxxxxx Xxxxxxxxxx, Xxxxxxxxxxxx 00000 Attention: Xxxxx XxXxxx Telephone: (000) 000-0000 Telecopy: (000) 000-0000 With a Copy To: Name: Agency Services, PNC Bank, National Association Mail Stop: P7-PFSC-05-W Address: 000 Xxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Attention: Agency Services Telephone: (000) 000-0000 Telecopy: (000) 000-0000 With a Copy To: Name: Xxxxx Xxxx Xxxxx Xxxx Address: One Oxford Centre 000 Xxxxx Xxxxxx, 00xx Xxxxx Xxxxxxxxxx, XX 00000-0000 Attention: Xxxx X. Xxxx, Esq. Telephone: (000) 000-0000 Telecopy: (000) 000-0000
Name: Address. City: State: Zip: Phone: Email address (if applicable) Number of space (s) $50 each: Number of Table (s) $15 each: Number of chairs (no charge) (Only one 8 ft table allowed per space. Put a zero here if you are bringing your own.) Do you need electric? Yes No You must bring your own extension cord as electric may not be directly behind your space! Please list and describe your crafts: If no self addressed stamped envelope or email address is provided, your cancelled check will be confirmation. Any special request? (We will try to accommodate as many as possible. This does not guarantee that we can accommodate you). Upon request we will have band students and band boosters available throughout the day to assist crafters. They can be utilized for loading and unloading crafts before and after the show. If you are interested, please sign this release form and return it with your signed contract and your check. LIABILITY RELEASE I agree that Green High School, Green Band Boosters, Band Students, and the Green School System are not liable and/or responsible for any damage and/or injuries in assisting in transporting crafts, display units, and/or any items related to the Craft Show.
Name: Address. Telephone: Professional affiliation of purchaser representative: The above-named purchaser representative has completed a Purchaser Representative Questionnaire, a copy of which is delivered to you with this agreement. I believe that I and the above-named purchaser representative, together have sufficient knowledge and experience in financial and business matters that together we are capable of evaluating the merits and risks of making an investment in the Units. The above-named purchaser representative has disclosed to me in writing prior to the date hereof any relationship between my purchaser representative and the following persons or entities or their affiliates: