Parent Signature: Parent Signature: Printer name: Printed name: NAME: To be read and signed by you as a member of Team: Crown Point Bulldog Hockey Club, Inc.
Printer may or may not, at its sole discretion, place Printer name and associated information (logo, address, slogan, disclaimer, etc) on the title page, copyright page or cover of book.
User Name means any user name allocated to the Customer for access to the Services;
Print Name Signature: Date:
s Name Property Address: _________________________________________________________
Printer means desktop printers, multifunction printer
Company Name Address: Attention: Tel: Fax: Email: For all correspondence except payments – Center for Technology Licensing at Cornell University Attention: Executive Director ▇▇▇ ▇▇▇▇ ▇▇▇▇ ▇▇▇▇, ▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ FAX: ▇▇▇-▇▇▇-▇▇▇▇ TEL: ▇▇▇-▇▇▇-▇▇▇▇ EMAIL: ▇▇▇-▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇.▇▇▇ Center for Technology Licensing at Cornell University ▇▇ ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇-▇▇▇▇ Receiving bank name: ▇▇▇▇▇▇▇▇ Trust Co. Bank account no.: 0111000065 Bank routing (ABA) no.: ▇▇▇▇▇▇▇▇▇ SWIFT code: Bank account name: ▇▇▇▇▇▇▇▇ Cornell University Bank ACH format code: Not required Bank address: ▇.▇. ▇▇▇, ▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ Additional information: Reference D-4730 Agreement No.: <to be assigned> An email copy of the transaction receipt shall be sent to ▇▇▇-▇▇▇▇▇▇▇▇▇@▇▇▇▇▇▇▇.▇▇▇. Licensee is responsible for all bank charges of wire transfer of funds for payments. The bank charges shall not be deducted from the total amount due to Cornell.