Contractor Name Business License #: Address: City, State, Zip Code: Telephone: Facsimile: Email: * If you are an independent contractor you are required to obtain a business license with the City of Thousand Oaks. Contractor certifies under penalty of perjury that Contractor is a Sole Proprietor Corporation Limited Liability Company Partnership Nonprofit Corporation Other [describe: ]
COMPANY NAME The Members may change the name of the Company or operate under different names, provided a majority of the Members agree and the name complies with Section 00-00-000 of the Act.
Project Name Register ASIC
CONTRACT NAME The name of this contract is Prepaid Mental Health Plan - Four Corners Community Behavioral Health Inc.
CONTRACTOR NAME CHANGE An amendment is required to change the Contractor's name as listed on this Agreement. Upon receipt of legal documentation of the name change the State will process the amendment. Payment of invoices presented with a new name cannot be paid prior to approval of said amendment.
Cable Television, Telephone & Internet Services Long Distance calling may be done only through the use of a prepaid phone card or by charges made to a third party number if using a provided, in room telephone. Neither the Institution nor the Manager guarantees the availability of telephone service or cable television services. If the Resident wants additional cable television, telephone or internet service above and beyond any that may be provided as “standard” in the Residence, the Resident must submit full details to and request and obtain the prior written approval of the Manager and Institution. With respect to Internet Services, the Institution may at its discretion only allow either the standard provided service or the approved alternate service and not both at the same time (Residents will need to complete the Institution’s standard forms issued by their IT department). Cutting of wiring, boring of holes, the use of wireless routers, routers, or switches are not permitted. Any unauthorized services or equipment may be removed by the Manager, at the Resident’s expense, without notice or liability. All Residents are subject to the Institution’s and/or Service Provider’s current Internet, cable television and telephone enrolment and usage policies.
Print Name Designation ...................................
Customer Services Customer Relationship Management (CRM): All aspects of the CRM process, including planning, scheduling, and control activities involved with service delivery. The service components facilitate agencies’ requirements for managing and coordinating customer interactions across multiple communication channels and business lines. Customer Preferences: Customizing customer preferences relative to interface requirements and information delivery mechanisms (e.g., personalization, subscriptions, alerts and notifications).
TRANSPORT SERVICES Upon the conclusion of such multilateral negotiations, the Parties shall conduct a review for the purpose of discussing appropriate amendments to this Agreement so as to incorporate the results of such multilateral negotiations.
Purchase Order and Sales Contact Name Please identify the individual who will be responsible for receiving and processing purchase orders and sales under the TIPS Contract.
