Subscriber Name. Last: First: Date of Birth: Drivers License/ID: State: Spouse name (or others who have authorization to make changes to this account): Last: First: Physical Address: Street: City: State: Zip: Mailing Address: Street: City: State: Zip: Home Phone: Cell Phone: Work Phone: Online Billing □ I would like to signup for online account access* Username: Password: *Online account access subject to Website Terms & Conditions available at xxxxxxxxxxxxxxxxxxx.xxx Email Address: Would you like to receive your billing statements by email? □ Yes | □ No
Subscriber Name. Lunn Partners Multiple Opportunities Portfolio L.P. Subscription Price (Tendered): $500,000 Accepted Amount: $500,000 Portion of Subscription Price Returned: $-0- Number of Shares to be issued: 15,625 ENTRADE INC., a Pennsylvania corporation By: _________________________ Title: _________________________ Date of Acceptance: January 3, 2000
Subscriber Name. Xx. Xxxxxxx X. Chafetz Subscription Price (Tendered): $500,000 Accepted Amount: $500,000 Portion of Subscription Price Returned: $-0- Number of Shares to be issued: 15,625 ENTRADE INC., a Pennsylvania corporation By: _________________________ Title: _________________________ Date of Acceptance: January 5, 2000
Examples of Subscriber Name in a sentence
Policyholder / Subscriber Name (Last, First, Middle Initial, Suffix), Address, City, State, ZIP Code14.
Cancelled cheque (containing Subscriber Name, Bank Account Number and IFS Code) or Bank Certificate Containing Name, Bank Account Number and IFSC code, for direct credit or electronic transfer.
SUBSCRIBER: Signature of Subscriber: Signature of Joint Subscriber, if applicable: By: By: Name: Name: Title: Title: Date: Name of Subscriber: Name of Joint Subscriber, if applicable: (Please print.
I, , authorize the monthly deduction of Rocky Mountain Health Plans premiums from my account(Print Name)for (Subscriber Name, if Different) Subscriber Signature: _ Account Holder Signature: _ Date: Fax: 970-244-7769 Email: billingreps@rmhp.org MK628-R10012020 NCColorado law requires carriers to make available a Colorado Health Benefit Plan Description Form, which is intended to facilitate comparison of health plans.
Data Element in Output Data Set: No Note: The NM1 Subscriber Name Loop 2010BA is used and processed only when the subscriber is the patient.Subscriber’s First NameData Element Name: Subscriber’s First Name Format-Length: AN – 35 Data Edit Specifications IP ED ASS S SRevision Date: April 2012 National Standard Mapping Electronic – 837I Version 5010RX12 Loop 2010BARef Des.
More Definitions of Subscriber Name
Subscriber Name. Address:___________________________ __________________________________ __________________________________ Mail or Deliver Exchange Agreement to: Statmon Technologies Corp. 0000 Xxxxxxxx Xxxxx Xxxxx 000 Xxxxx Xxxxxxxxxxx, XX 00000 Attn: Xxxxxxxx X. Xxxxxx Agreed to and accepted by: STATMON TECHNOLOGIES CORP., a Nevada corporation By:____________________________________ Name:_________________________________ Its:____________________________________ Date:__________________________________
Subscriber Name. Service Address: City: State: Zip Code: Account:
Subscriber Name the entity that has entered into the Subscriber Agreement (as defined in Schedule 5). Location Address: the full postal address for the location of the entity that receives Information. Reporting Codes: unique identifiers for the Information and usage package as set out in the Schedules.
Subscriber Name. Last: First: Date of Birth: Spouse name (or others who have authorization to make changes to this account): Last: First: Online Billing □ I would like to signup for online account access* Username: Password: *Online account access subject to Website Terms & Conditions available at xxxxxxxxxxxxxxxxxxx.xxx Physical Address: Street: City: State: Zip: Mailing Address: Street: City: State: Zip: Home Phone: Cell Phone: Work Phone: Other: Email Address: Would you like to receive your billing statements by email? □ Yes | □ No Router: □ Yes | □ No Managed: □ Yes | No Due to processing & mail increases Customers receiving Statements by Mail will be charged $1.00 per month. Effective 4/1/19 □ Basic Web Browsing (Up to 2Mb/s) $54.99 $29.99 $84.98 □ □ Basic Video Streaming & Gaming (Up to 6Mb/s) $54.99 $39.99 $94.98 □ □ Advanced Video Streaming & Gaming (Up to 8Mb/s) $54.99 $49.99 $104.98 □ □ Basic Multi-User (Up to 12Mb/s) $54.99 $59.99 $114.98 □ □ Advanced Multi-User (Up to 15Mb/s) $54.99 $69.99 $124.98 □ Internet Service Plans Package Start-Up Fee Monthly Fee
Subscriber Name. Email: Date: Issuer: By: /s/ Mxxx X. Xxxxxxx Name: Mxxx X. Xxxxxxx Company: Level Brands, Inc. Title: Chief Financial Officer and Chief Operating Officer
Subscriber Name. Email: Date: Signature ID: _____________________ Legal Name of Entity By _____________________ Subscriber: _____________________ Name: Email: Date: Signature ID: _____________________ Name: Title: State/Country of Domicile or Formation: _______________________________________________________________ The offer to purchase Securities as set forth above is confirmed and accepted by the Company as to _____________________ Securities for $ _____________________. 6D BYTES INC. By _____________________ Issuer: _____________________ Name: Email: Company: Title: Signature ID: _____________________ Name: 6D BYTES INC. Title: Xxxxx Xxxx [a] Escrow Agent has not investigated the desirability or advisability of investment in the Securities nor approved, endorsed or passed upon the merits of purchasing the Securities; and the name of Escrow Agent has not and shall not be used in any manner in connection with the Offering of the Securities other than to state that Escrow Agent has agreed to serve as escrow agent for the limited purposes set forth in this Agreement.
Subscriber Name. Xxxx to the attention of: Address: Phone Number: Fax Number: Vendor providing service: For purpose of qualifying for OPRA's reduced member subscriber fee, Subscriber certifies that It is a member or associate member In good standing of the following Participant Exchanges (check all that apply): / / American Stock Exchange / / Chicago Board Options Exchange / / New York Stock Exchange / / Pack Stock Exchange / / Philadelphia Stock Exchange FOR OPRA USE ONLY APPROVED: Subscriber No. OPTIONS PRICE REPORTING AUTHORITY Location No. 000 XXXXX XXXXXXX XXXXXX Start Date XXXXXXX, XXXXXXXX 00000 Number of Devices USA (000)-000-0000 By Date of Approval Subscriber remains responsible for all fees due to OPRA hereunder, even if a third party has agreed to pay such fees on behalf of Subscriber * Whenever an asterisk follows the first use of a term, Paragraph I defines the term. AGREEMENT FOR RECEIPT OF CONSOLIDATED NETWORK A DATA AND NYSE MARKET DATA This Agreement permits the undersigned "Subscriber to arrange with authorized vendors or with the New York Stock Exchange, Ink. ("NYSE"), as appropriate to receive any one or more Types of Market Data* and to use that Market Data for interrogation* display, tape* display or other purposes not entailing retransmission. This Agreement governs whichever Type(s) of Market Data, means of receipt and use(s) Subscriber receives, arranges and makes. Subscriber and NYSE agree to all terms and conditions of this Agreement. Subscriber Name: Xxxxxx Xxxx & Xxxxxxxx 0000 Xxx Xxxxxx, Ste. 301 Houston, TX 77056 USA Name and Title of Individual Signing: Xxxxx X . Xxxx Billing address if different than above: same as above Taxpayer ID or Social Security No. ###-##-#### Type of Business: Investment Banking Tel. No. 000-000-0000 CHECK BOX IF MEMBER OF: American Stock Exchange, Inc. / / Cincinnati Stock Exchange, Inc. / / New York Stock Exchange, Inc. / / Boston Stock Exchange, Inc. / / Midwest Stock Exchange, Inc. / / Pacific Stock Exchange, Inc. / / Chicago Board Options Exchange, Inc. / / National Association of / / Philadelphia Stock Exchange, Inc. / / Securities Dealers, Inv. SUBSCRIBER , NEW YORK STOCK EXCHANGE, INC. On behalf of the CTA Plan Participants (in respect of CTA Network A last sale information) and the CQ Plan Participants (in respect of CQ Network A quotation information) and on its own behalf solely (in respect of NYSE Securities Information*) By: Xxxxx X. Xxxx By: Dated: Dated: