AUTHORIZATION AND ACKNOWLEDGEMENT. I authorize Xxxxx Management to obtain reports from any consumer or criminal record reporting agencies before, during, and after tenancy on matters relating to my Application and Lease with Xxxxx Management and to verify, by all available means, the information in this Application, including criminal background information, income and housing history, and other information reported by any state or federal agency (ex: Social Security Administration). I understand that this authorization cannot be used to obtain any information about me that is not pertinent to my eligibility and continued participation as a qualified applicant or resident.
AUTHORIZATION AND ACKNOWLEDGEMENT. Each of the Lenders party hereto hereby (a) authorizes the Administrative Agent to execute and deliver the New Borrower Mortgage Amendments in its capacity as Administrative Agent by and on behalf of such Lender and (b) acknowledges and authorizes the agreement of the Administrative Agent and the Canadian Administrative Agent, as applicable, set forth in Section 13 of this Agreement with respect to the Credit Insurance Policy and Section 14 of this Agreement with respect to the New Borrower Mortgage Amendments.
AUTHORIZATION AND ACKNOWLEDGEMENT. I understand that I cannot revoke or change this election during the year unless there is a qualifying "Status Change". The requested election change must be consistent and in line with the qualifying event (QLE). I may then revoke my prior election and sign a new Agreement if such a change occurs. QLEs include a change in your legal marital status, birth of a child, date you adopt a child, death of spouse or dependent, loss of employment, or your child reaches the age 13 or change in child care services. Changes must be submitted within 30 days of the qualifying life event (QLE). I understand that when I submit a claim, I must include appropriate documentation (e.g. explanation of benefits from my Insurance Provider, itemized bill, etc.) for out-of-pocket Medical, Dental, Vision expenses before I can be reimbursed. All eligible expenses/claims must be incurred during the time that I participate in the plan in order to be eligible for reimbursement. I hereby elect to participate in Flexible Spending Account as indicated on this form. I authorize Plainview-Old Bethpage CSD to make pretax deductions from my salary on the payroll schedule I have elected above. Employee's Name Date:
AUTHORIZATION AND ACKNOWLEDGEMENT. I understand that I cannot revoke or change this election during the year unless there is a qualifying status change. The requested election change must be consistent and in line with the qualifying life event (QLE). I may then revoke my prior election and sign a new Agreement if such a change occurs. QLEs include a change in your legal marital status, birth/adoption of a child, death of spouse or dependent, loss of employment, or your child reaches age 13 or has a change in child care services. Changes must be submitted within 30 days of the qualifying life event (QLE). I understand that when I submit a claim and appropriate documentation (e.g. explanation of benefits from my Insurance Provider, itemized bill, etc.) for out-of-pocket Medical, Dental, Vision expenses before I can be reimbursed. I hereby elect to participate in Flexible Spending Account as indicated on this form. I authorize the Great Neck Public Schools to make pretax deductions from my salary on the payroll schedule I have elected above. I hereby agree to pay the administrative fee for my account(s) and agree that the monthly contribution of $4.45 will be deducted in equal amounts each pay period. Employee's Signature Date: Deadline for enrollment is November 20, 2020, or the next business day if November 20 falls on a weekend.
AUTHORIZATION AND ACKNOWLEDGEMENT. IMPORTANT INFORMATION ABOUT HEALTHCARE PROVIDER RELATIONSHIPS AND HEALTHCARE PROVIDER LISTS In connection with using the Site and the Services to locate and schedule appointments with Healthcare Providers, you understand that: YOU ARE RESPONSIBLE FOR CHOOSING YOUR OWN HEALTHCARE PROVIDER, INCLUDING WITHOUT LIMITATION, DETERMINING WHETHER THE APPLICABLE HEALTHCARE PROVIDER IS SUITABLE FOR YOUR HEALTHCARE NEEDS BASED ON SPECIALTY, EXPERIENCE, QUALIFICATION, LICENSES AND OTHER IMPORTANT FACTS AND CIRCUMSTANCES THAT COULD IMPACT YOUR CARE. Drfactor or its designee takes certain limited steps to (a) verify that Healthcare Providers participating in the Services hold certain active licenses, certifications or registrations required by law to practice the specialties of the services offered by them through the Services, and (b) verify that Healthcare Providers are not listed in the U.S. Department of Health and Human Services Office of the Inspector General Exclusion database. Drfactor may also exclude Healthcare Providers from our Services who, in Xxxxxxxx’s discretion, have engaged in inappropriate or unprofessional conduct. Some Healthcare Providers listed through the Services enter into contracts with us, and may pay us a fee in order to be marketed through or to use the Services. To help you find Healthcare Providers who may be suitable for your needs, and enable the maximum choice and diversity of Healthcare Providers participating in the Services, we will provide you with lists and/or profiles of Healthcare Providers. These results are based on information that you provide to us, such as insurance information, geographical location, and healthcare specialty. They may also be based on other criteria (including, for example, Healthcare Provider availability, past selections by and/or ratings of Healthcare Providers by you or by other Drfactor users, and past experience of Drfactor users with Healthcare Providers). Note that Drfactor (a) does not recommend or endorse any Healthcare Providers, (b) does not make any representations or warranties with respect to these Healthcare Providers or the quality of the healthcare services they may provide, and (c) does not receive any additional fees from Healthcare Providers for featuring them (i.e., higher or better placement on lists) through the Services (subject to Sponsored Results as described below). Note, however, to the extent that you use the Services as provided by your employer, Drfactor may provide lists an...
AUTHORIZATION AND ACKNOWLEDGEMENT. 1. I hereby authorize the Columbus Metropolitan Housing Authority (CMHA) and its agents, including financial institutions, to deposit payments by electronic funds transfer (ACH).
AUTHORIZATION AND ACKNOWLEDGEMENT. You hereby authorize NextEra Energy Services, for the duration of this Agreement, to become your CEP and act as your limited agent to perform the necessary tasks to establish electricity supply from NextEra Energy Services. By accepting this Agreement (including the TOS), you hereby affirmatively consent to the EDC sharing your billing and payment information with us, including any participation by you in budget billing or extended payment arrangements. Whether you have signed below or provided verbal authorization to NextEra Energy Services over the telephone (the “Verbal Authorization”), you agree that, as of the Effective Date or upon receipt of this Agreement, whichever is later, (i) you have read this Agreement and hereby agree to all the terms and conditions set forth in the Agreement; and (ii) you authorize NextEra Energy Services to obtain from the EDC and review your EDC information with respect to the Accounts. Further, you hereby represent and warrant to NextEra Energy Services that you (or the person signing this BEA on your behalf if you are an entity): (i) are the EDC account holder; (ii) are authorized by the EDC to make changes to the commercial Accounts set forth in Addendum A; (iii) are 18 years of age or older; (iv) desire to obtain electricity supply for such Accounts from NextEra Energy Services instead of your current CEP; and (v) whether you have signed below or provided Verbal Authorization to NextEra Energy Services, you are legally authorized to enter into this Agreement with regard to all Accounts. This Agreement is not valid or binding unless and until signed by both Parties (for written agreements, a facsimile will be accepted as if it were an original) and you have provided your Verbal Authorization. Customer expressly confirms the following:
AUTHORIZATION AND ACKNOWLEDGEMENT. In consideration of the North Toronto Soccer Club accepting the applicant child to participate as a guest Player in its programs, the Parent or Guardian
AUTHORIZATION AND ACKNOWLEDGEMENT. Prepaid Debit Card
AUTHORIZATION AND ACKNOWLEDGEMENT. For the purpose of reimbursement of fees for services rendered by you during my treatment, I authorize you to release any necessary information to third party payers, insurance companies, attorneys or other relevant parties to secure payment for such services. I also acknowledge and affirmatively represent that the information provided by me regarding my health care coverage is true, accurate and complete to the best of my knowledge.
