s Name Property Address: _________________________________________________________
User Name means any user name allocated to the Customer for access to the Services;
Print Name Signature: Date:
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.
Street Name means the form of registration in which the securities are held by a broker who is delivering the securities to another broker for the purposes of sale, it being an accepted custom in the United States securities industry that a security in Street Name is in proper form for delivery to a buyer and that a security may be re-registered by a buyer in the ordinary course.