Please Check. ONE: 🗆 New Applicant �� Change Request 🗆 Cancel Auto Debit Name: Mailing Address: City, State, Zip: Service Address: Account Number: Daytime Phone: ( ) Cell Phone: ( ) Email Address: Please provide the following information about your bank account: Name on the Bank Account: Bank Name: Routing Number: Account Number: I authorize Gum Creek Water Supply Corporation to automatically deduct payment from the account specified, for charges incurred at my service address. I understand that payment will be deducted between the 7th and the 10th of every month and therefore, no other payment need be mailed. I also understand that I will be subject to a return check fee if my bank rejects the bank draft for any reason. I further understand that I have the right to receive notice of the amount of each payment deduction and that each bill will be marked with the payment that will be automatically drafted. The monthly bill will constitute such notice. I may suspend payment by notifying Gum Creek Water Supply in writing a minimum of ten business days before an amount is to be debited from my bank account. I also understand Gum Creek Water Supply reserves the right to terminate this draft and/or my participation in it. I have read and agree to the above authorization agreement. Signature: Date: Automatic recurring bank draft will begin within 4 weeks of receipt of this form & voided check. Please complete form, sign and ATTACH A VOIDED CHECK. Mail to: Gum Creek WSC
Please Check all Sports that you or a family member would like to work: We will try to put you where you want to be, but we need all spots filled so you may be asked to work other events. Girls Volleyball – Scorebook, Scoreboard, Libero Trackers, Tickets, Line Judges, Concessions MS 9/JV Varsity Football – Announcer, Scoreboard, Tickets, Spotter, Chains, Concessions JV Varsity Basketball – Scorebook, Scoreboard, Tickets, Announcer, Concessions MS Girls MS Boys JV Girls/Boys Varsity Girls/Boys Wrestling – Tickers, Timer, Score, Scorebook, Xxxxx Xxxxxx, Concessions MS Varsity Track – Clerk, Recorder, Back-Up Timer, Hurdles, Exchange Zone, Field Event Judges, Scorekeeper, Announcer, Tickets, Concessions MS Varsity Baseball – Scoreboard and Announcing JV Varsity Softball – Scoreboard and Announcing JV Varsity Please mark all tournaments that you or your family members may be able to work. (Dates and times may change.) Volleyball (Scoreboard, Scorebook, Line judges, Tickets, Concessions) Saturday, September 18th, 2021 @ 8 am – Varsity Volleyball Inv. Saturday, October 23rd, 2021 @ 8 am – JV Volleyball Inv. Wrestling (Tickets, Timer, Scorebook, Scoreboard, Xxxxx Xxxxxx) Saturday, December 4th, 2021 @ 9 am – MS Wrestling Inv. Saturday, January 8th, 2022 @ 9:30 am – Varsity Wrestling Inv. Track (Timers, Pickers, Exchange Zone, Field Event Judges, Scorekeeper, Announcer, Tickets) Saturday, April 16th, 2022 @ 9 am – St. Louis Track Invite Softball (Tickets, Scoreboard, Scorekeeper) Saturday, May 21st 2022 @ 10:30 am – Varsity Softball Tournament Baseball (Tickets, Scoreboard, Scorekeeper) Saturday, May 21st, 2022 @ 10:30 am – Varsity Baseball Tournament If you are working for a family pass, the members in your household will have to work a combined total of 18 events. If you are working for an adult pass you will have to work 8 events. Students must work 6 events.
Please Check. Is this the main job? Is this a part-time job?
Examples of Please Check in a sentence
Agreement Requirements (Please Check Both) Yes, I have provided a detailed Scope of Work document (SOW) and baseline requirements.
Name on the Card: Please Check One: VISA MC DISC AMEX Credit Card Number: Expiration Date: / CVN: ZIP: Authorized Weekly Payment Amount: $250.00 Week | 5% Loads Starting on / / 20 Ending on / / 20 This authorization is to remain in full force and effect until the ending date listed above.
Automatic Withdrawal Authorization Agreement Type of Agreement - Please Check Box Below: New Election Change as of Cancellation Name: (please print) Fermilab ID #: Home Telephone Number: (please include area code) Last 4 Digits of Social Security Number: I hereby authorize Fermi National Accelerator Laboratory to withdraw funds from my account, for payment of my insurance premiums and, if necessary, make adjustments to correct any errors or to facilitate changes to premium amounts.
Name on the Card: Please Check One: VISA MC DISC AMEX Credit Card Number: Expiration Date: / CVC: ZIP: Authorized Weekly Payment Amount: 10% Starting on / / 20 Ending on / / 20 This authorization is to remain in full force and effect until the ending date listed above.
Agreement Requirements (Please Check Both) Yes, I have provided a detailed Scope of Work document (SOW).
More Definitions of Please Check
Please Check. One: Personal Account Business Account Name same as above Void Cheque Enclosed Account Holder: (If different from above) Financial Institution (name): Account #: Transit # (5 digits): Bank # (3 digits): Bank Address: Account Holder Signature: Date: Secondary Account Holder Signature: (if necessary) Date: You, the payor, may revoke your authorization at any time in writing subject to providing ND Energy Inc. at least 30 business days’ notice before the next debit is scheduled. To obtain a cancellation form, contact ND Energy Inc., your Financial Institution or visit xxx.xxxxxx.xx. For more information on your right to cancel, contact your financial institution or visit xxx.xxxxxx.xx. ND Energy Inc. may assign your authorization, whether directly or indirectly, by operation of law, change of control or otherwise, and shall provide written notice to you following such assignment. The t e r m s and conditions set out in this agreement comprise the legally binding agreement between the Customer and ND Energy Inc. (“ND Energy”) governing the Customer’s use of the Services (as defined below). Please read the following carefully as well as ND Energy’s Conditions of Service. The Customer acknowledges and agrees as follows:
Please Check. ONE POSITION OR LOCATION BELOW: ☐Administrator ☐Teacher or Paraprofessional ☐School Staff ☐Central Office ☐Contract Worker ☐Homeless Ed ☐Int’l Center ☐Maintenance ☐Performing Arts Center ☐Prof. Learning Center Pre-K Development Safety & Security Technology Transportation I acknowledge: • The ID Badge should be worn and visible at all times while at work. • The badge is not to be left in direct sunlight or heat. • In the event the badge is damaged, lost, or stolen, I will immediately notify my supervisor who will notify the CCPS Electronics Department at 000-000-0000. • Payments for badges that are damaged, lost, or stolen are $25.00. Checks and money orders made payable to “Clayton County Public Schools” at “0000 Xxxxx Xxxxxx, Xxxxxxxxx, XX” are the only acceptable forms of payment. • The badge must be returned to my supervisor or CCPS Facilities Services Department immediately when directed by district authorities or upon termination of my employment with CCPS. I have read and agree to the above terms and conditions. I agree to cooperate fully with any investigation(s) in reference to lost or stolen badges. EMPLOYEE SIGNATURE: Administration Signature: Name:
Please Check. (Note: This form is valid ONLY if ALL 4 boxes are checked.) ⬜ I agree to the above terms of the Israel Option. ⬜ I agree to the withdrawal policy. (Please refer to the Tuition Refund and Withdrawal Policy.) ⬜ I understand that my participation in the Israel Option is subject to the policies and procedures outlined in the student handbook, which can be found online at xxx.xxx.xxx.
Please Check. New MORNETPlus Subscriber Change MORNETPlus Subscriber Delete MORNETPlus Subscriber If new MORNETPlus Subscriber, please indicate the number of computers on which you will install the application:__ If an existing MORNETPlus Subscriber, please provide: MORNETPlus Subscriber ID:. a0129sns Please provide the following information: Licensee Company Name: First Mortgage Network Licensee Address: 0000 Xxxxxxx Xxxx Xxxx, Xxxxx, Xxx Code: Xxxxxxxxxx, XX 00000 Licensee Contact Person/Title: (will receive software) Xxxxxx Xxx Xxxx Phone Number: (000)000-0000 Fax Number: Please enter the 9-digit Seller/Servicer Number(s) of the organization(s) for whom you will be underwriting. Seller/Servicer Number(s)*: 1.22961-000-7 2. - - 3. - -
Please Check. One : Personal Account Business Account Void Cheque Enclosed Account Holder: (If different from above) Financial Institution (name): Account #: Transit # (5 digits): Bank # (3 digits): Bank Address: Account Holder Signature: Date: Secondary Account Holder Signature: (if necessary) Date: You, the Payor, acknowledge that (Processing Institution) is not required to verify that a PAP has been issued in accordance with the particu lars of the Payor’s Authorization including, but not limited to, the amount; and also acknowledge that Processing Institution is not required to verify that any purpose of payment for which the PAP was issued has been fulfilled by ND Energy Inc. as a condition honoring a PAP issued or caused to be issued by ND Energy Inc. on your account. You may revoke your authorization at any time in writing subject to providing ND Energy Inc. at least 30 business days’ notice before the next debit is scheduled. To obtain a cancellation form, contact ND Energy Inc. or your Financial Institution. For more information on your right to cancel, contact your financial institution or xxxxxxxx.xxxxxx.xx. ND Energy Inc. may assign your authorization, whether directly or indirectly, by operation of law, change of control or otherwise, and shall provide written notice to you following such assignment. TERMS AND CONDITIONS Pre-Authorized Payments will be processed on the due date and will be based on the amount stated on your current invoice. If alternate payments are made, your account will still be debited the full amount listed on your invoice. Once on the Plan, you will continue to receive your ND Energy bill as usual. Revocation of this authorization does not terminate any contract for goods or services that exists between you, the Payor, and ND Energy Inc. The Payor’s authorization applies only to the method of payment and does not otherwise have any bearing on the contract for goods or services exchanged. Upon termination, ANY AMOUNT DUE shall be paid directly to ND Energy. Cancellation of pre-authorized debit (PAD) does not constitute cancellation of service by ND Energy Inc. and the customer shall be liable for any past, present or future amounts owing. You have certain recourse rights if any debit does not comply with this agreement. For example, you have the right to receive reimbursement for any debit that is not authorized or is not consistent with this PAD Agreement. To obtain more information on your recourse rights, contact your financia...
Please Check. One : 🞎 Personal Account �� Business Account 🞎 Name same as above 🞎 Void Cheque Enclosed Account Holder: (If different from above) Financial Institution (name): Account #: Transit # (5 digits): Bank # (3 digits): Bank Address: Account Holder Signature: Date: Secondary Account Holder Signature: (if necessary) Date: You, the payor, may revoke your authorization at any time in writing subject to providing ND Energy Inc. at least 30 business days’ notice before the next debit is scheduled. To obtain a cancellation form, contact ND Energy Inc., your Financial Institution or xxxxxxxx.xxxxxx.xx. For more information on your right to cancel, contact your financial institution or visit xxx.xxxxxx.xx. ND Energy Inc. may assign your authorization, whether directly or indirectly, by operation of law, change of control or otherwise, and shall provide written notice to you following such assignment. Landlord/Legal Owner: By signing this agreement, you agree to be the interim account holder for the services to the Rental property. You understand that whenever a tenant calls to close their ND Energy account, you will automatically assume responsibility for the utility account and continued services starting on the Tenant’s termination date and until such time as a new tenant establishes an account with ND Energy. No reconnection or new account charges will apply to you under this option. Landlord/Legal Owner Signature X Date: The terms and conditions set out in this agreement comprise the legally binding agreement between the Customer and ND Energy Inc. (“ND Energy”) governing the Customer’s use of the Services (as defined below). Please read the following carefully as well as ND Energy’s Conditions of Service. The Customer acknowledges and agrees as follows:
Please Check. Name/Address/phone/fax/email