Credit Card Authorisation Form Sample Clauses

Credit Card Authorisation Form c. Attach confirmation of your current membership with a registered health insurer indicating appropriate level of policy that covers insulin pumps.
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Credit Card Authorisation Form. For office use only: Booking Name Date of Travel Bank Auth. Code Attention: Debtors Team Telephone: +00 00 000 0000 Vax: +00 (0) 000 000 0000 E-Mail: xxxxxxx@xxxxxxxxx.xxx CREDIT CARD AUTHORISATION FORM: Reservation No. Invoice No. Curr. Invoice Amount Total amount to be deducted -  PLEASE NOTE: All amounts will be converted into and deducted in Rand (ZAR) at the Rate of Exchange applicable on date of the transaction. The quoted exchange rate and amount in ZAR is valid for a period of three days from date of quote. Diners Club Master Card Visa Card Card Type: Bank Name: Expiry Date (MM/YY): Card Number: Security No: Last three (3) digits on the back of the card: Name (as printed on card): Billing Address: Contact Telephone Number (Home): Contact Telephone Number (Work): Passport or ID Number: Date of Birth: I, hereby authorise &Beyond to debit my credit card as detailed above Signature: Date: The Above Information is essential to ensure success in processing. Any omissions may result in your card being rejected. Should this be caused by incorrect /insufficient information or insufficient funds, &Beyond reserves the right to release the reservation. Re-instatement will be pending correct/sufficient information and funds, and is subject to availability of room at the time of re-instatement. PLEASE KINDLY CONTACT YOUR BANK TO ADVISE THEM THAT WE WILL BE APPLYING FOR AUTHORISATION TO DEBIT YOUR CREDIT CARD ACCORDING TO THE SPECIFIED AMOUNTS & DATES ABOVE. PLEASE NOTE: IT IS A BANK REQUIREMENT THAT A COPY OF THE FRONT AND BACK OF THE CREDIT CARD IS FAXED THROUGH WITH THIS

Related to Credit Card Authorisation Form

  • Credit Card Authorization TO THE EXTENT PERMITTED BY APPLICABLE LAW, YOU IRREVOCABLY AND UNCONDITIONALLY AUTHORIZE XXXXXXX TO CHARGE ALL AMOUNTS DUE UNDER THIS AGREEMENT TO ANY CREDIT CARD YOU PROVIDE TO US, AND YOU AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS XXXXXXX WITH RESPECT TO THE SAME.

  • Qualified Credit Card Issuer A UK Financial Institution satisfying the following criteria:

  • ACH Authorization Merchant authorizes Service Provider to initiate debit/credit entries to the Designated Account, the Reserve Account, or any other account maintained by Merchant at any institution, all in accordance with this Agreement. This authorization will remain in effect beyond termination of this Agreement. In the event Merchant changes the Designated Account, this authorization will apply to the new account.

  • Credit Cards About 93% of graduating students report they have at least one credit card, including 29% who say they have two or more. Among those students who have credit cards, about 79% report they pay off their balance each month and, as such, their current credit card balance is zero; however, when asked what their current credit card balance is, just 37% say it is zero. Among those with an unpaid balance, the average credit card debt students have is $2,771. Table 47: Credit cards All students (n=14,760) Group University of Victoria (n=339) 1 (n=3,531) 2 (n=6,238) 3 (n=4,991) Number of credit cards (FIN1) None 7% 8% 7% 7% 4% One 64% 65% 62% 66% 65% Two 21% 19% 22% 20% 24% Three or more 8% 7% 8% 7% 8% Regularly pay off balance each month* (FIN2) Yes 79% 70% 81% 80% 77% Total credit card balance* (FIN3) Zero 37% 34% 37% 38% 39% $500 or less 14% 14% 13% 14% 12% $501 to $1,000 6% 6% 6% 7% 5% Over $1,000 10% 14% 8% 10% 10% Don't know 33% 32% 36% 31% 34% Average (those with credit card) $792 $1,176 $655 $753 $639 Average (those with unpaid balance) $2,771 $3,366 $2,395 $2,745 $2,334 * Total credit card balance and payment of the balance were asked of those who had at least one credit card.

  • Disclosure Statement for Xxxxxxxxx Education Savings Accounts 1. Who is Eligible for a Xxxxxxxxx Education Savings Account? Anyone may contribute to a Xxxxxxxxx Education Savings Account regardless of his or her relationship to the beneficiary. The beneficiary of a Xxxxxxxxx Education Savings Account

  • KEY-SAFE / LOCKBOX The Owner: (check one) ☐ - Authorizes the use of a key-safe / lockbox to allow entry into the Property. ☐ - Does not authorize the use of a key-safe / lockbox to allow entry into the Property.

  • Visa Debit Card You may use your Card to purchase goods and services from participating merchants. If you wish to pay for goods or services over the Internet, you may be required to provide card number security information before you will be permitted to complete the transaction. You agree that you will not use your Card for any transaction that is illegal under applicable federal, state, or local law. Funds to cover your Card purchases will be deducted from your checking account. If the balance in your account is not sufficient to pay the transaction amount, the Credit Union may pay the amount and treat the transaction as a request to transfer funds from other deposit accounts, approved overdraft protection accounts or loan accounts that you have established with the Credit Union. If you initiate a transaction that overdraws your Account, you agree to make immediate payment of any overdrafts together with any service charges to the Credit Union. In the event of repeated overdrafts, the Credit Union may terminate all services under this Agreement. You may use your Card and PIN (Personal Identification Number) in ATMs of the Credit Union, Plus, VISA, CO-OP, and ACCEL networks, and such other machines or facilities as the Credit Union may designate. At the present time, you may also use your Card to: • Make deposits to your share savings and checking accounts. • Transfer funds from your share savings and checking accounts. • Obtain balance information for your share savings and checking accounts. • Make certain loan payments from your share savings and checking accounts. • Access your Personal Line of Credit account. • Make POS (Point-of-Sale) transactions with your Card and PIN (Personal Identification Number) to purchase goods or services at merchants that accept Visa. • Order goods or services by mail, Internet or telephone from places that accept Visa. • Some functions may be limited at non-proprietary ATMs; features may be limited to POS only, according to merchant. • Withdraw funds from your share savings and checking accounts. The following limitations on the frequency and amount of Visa Debit Card transactions may apply: • You may make 15 Debit Card purchases per day. • You may purchase up to a maximum of $3,500.00 per day. • You may make 15 cash withdrawals in any one (1) day from an ATM machine. • You may withdraw up to a maximum of $500.00 in any one (1) day from an ATM machine, if there are sufficient funds in your account. • You may make 15 POS transactions in any one (1) day. • You may purchase up to a maximum of $3,500.00 from POS terminals per day, if there are sufficient funds in your account. • You may transfer up to the available balance in your accounts at the time of the transfer. • If you incur a charge in a currency other than U.S. dollars, the charge will be converted into the US dollar amount. Please see the Foreign Transactions section below. Also, transactions in certain countries may be blocked and will require a manual or verbal authorization for approval. Please check with us prior to departure to determine if your destination country is atfected. However, the right to deny such transactions is within our sole discretion and atfected countries may change at any time.

  • Letter of Authorization Each Party is responsible for obtaining a Letter of Authorization (LOA) from each End User initiating transfer of service from one Party to the other Party in accordance with applicable law. The Party obtaining the LOA from the End User will furnish it to the other Party upon request. The Party obtaining the LOA is required to maintain the original document, for a minimum of twenty-four (24) months from the date of signature. If there is a conflict between an End User and Carrier regarding the disconnection or provision of services, Frontier will honor the latest dated Letter of Authorization. If the End User’s service has not been disconnected and services have not yet been established, Carrier will be responsible to pay the applicable service order charge for any order it has placed. If the End User’s service has been disconnected and the End User’s service is to be restored with Frontier, Carrier will be responsible to pay the applicable nonrecurring charges as set forth in Frontier applicable tariff to restore the End User’s prior service with Frontier.

  • Credit Card If you choose to pay by credit card, you will be prompted to provide your credit card information and will be presented with a screen that reflects the amount of your subscription, the amount of fees that would be charged by the credit card issuer for the transaction and the total amount payable.

  • AGENT AUTHORIZATION FORM I/We, (Print Bidder name) , Do hereby authorize (print agent’s name), , to act as my/our agent to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, (IFB NUMBER AND TITLE) , and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Signature of Bidder Date STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) LEASED EMPLOYEE AFFIDAVIT I affirm that an employee leasing company provides my workers’ compensation coverage. I further understand that my contract with the employee leasing company limits my workers’ compensation coverage to enrolled worksite employees only. My leasing arrangement does not cover un-enrolled worksite employees, independent contractors, uninsured sub-contractors or casual labor exposure. I hereby certify that 100% of my workers are covered as worksite employees with the employee leasing company. I certify that I do not hire any casual or uninsured labor outside the employee leasing arrangement. I agree to notify the County in the event that I have any workers not covered by the employee leasing workers’ compensation policy. In the event that I have any workers not subject to the employee leasing arrangement, I agree to obtain a separate workers’ compensation policy to cover these workers. I further agree to provide the County with a certificate of insurance providing proof of workers’ compensation coverage prior to these workers entering any County jobsite. I further agree to notify the County if my employee leasing arrangement terminates with the employee leasing company and I understand that I am required to furnish proof of replacement workers’ compensation coverage prior to the termination of the employee leasing arrangement. I certify that I have workers’ compensation coverage for all of my workers through the employee leasing arrangement specified below: Name of Employee Leasing Company: Workers’ Compensation Carrier: A.M. Best Rating of Carrier: Inception Date of Leasing Arrangement: I further agree to notify the County in the event that I switch employee-leasing companies. I recognize that I have an obligation to supply an updated workers’ compensation certificate to the County that documents the change of carrier. Name of Contractor: Signature of Owner/Officer: Title: Date: INFORMATION FOR DETERMINING JOINT VENTURE ELIGIBILITY If the bidder is submitting as a joint venture, please be advised that this form MUST be completed and the REQUESTED written joint-venture agreement MUST be attached and submitted with this form. HOWEVER, IF THE BIDDER IS NOT A JOINT VENTURE, CHECK THE FOLLOWING BLOCK: ( ) NOT APPLICABLE

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