Name Telephone Number. FOR THE BUYER: Ian X.X. Xxxxxx (000) 000-0000
Name Telephone Number. My signature indicates that I have read and agree to be bound by the conditions noted on the following six pages of this application/agreement. Signature of Resident Date Signature of Parent/Guardian Date (If applicant is younger than 18 years of age) OFFICE USE ONLY: PLEASE DO NOT WRITE BELOW THIS LINE ID Number Room Assignment 1 Room Assignment 2 Date Received Date Date RESIDENCE LIFE AGREEMENT
Name Telephone Number. GENERAL INFORMATION Brand name of panel most commonly used by your company: Type of receiver format you prefer: Please indicate the best method for contacting you after business hours. Service Pager Home Mobile Number Leave Message? Yes No Company Name to Use When Dispatching: Phone number to give to your customers: Phone number to transfer your customers to: CONTACT INFORMATION Billing Contact Name: Phone: Email: Data Entry Name: Phone: Email: Activity Reports Name: Phone: Email: Runaway Accounts: Name: Phone: Email: Name: Phone: Email: Name: Phone: Email: REPRESENTATIVES List all owners, officers and employees who will be in contact with the Central Station for any reason pertaining to your company’s accounts. Each representative should have a unique PIN that is 5 numbers in length. Email Addresses are required for NetConnect access. User names will be the email listed for each individual. NetConnect login is case sensitive.
Name Telephone Number. 1. Xxxxx X. Xxxxxxxx (000) 000-0000
Name Telephone Number. NOTE TO INTERESTED VENDORS* – Due to security concerns, all offerors must contact the above U.S. Government representative and email the names and company name of all individuals who will represent the company at the pre-proposal conference to xxxxxx-xxx-xxxxxxxxx@xxxxx.xxx . On the date of the pre-proposal conference, company representatives must present matching photo identification in order to be allowed access. Anyone attempting to attend the pre-proposal conference without prior notification will be denied entry.
Name Telephone Number. GENERAL INFORMATION Brand name of panel most commonly used by your company: Type of receiver format you prefer: Please indicate the best method for contacting you after business hours. Service Pager Home Mobile
Name Telephone Number. I consent for my therapist and office manager to communicate with me by mail and phone at the following location, & number, and I will provide timely notification of any changes.
Name Telephone Number. Address ECINS Profile/Case Ref No. (If applicable) Secure Email for response: (Restricted when complete) INFORMATION SHARING AGREEMENT FOR ANTI SOCIAL BEHAVIOUR – Appendix B DERBYSHIRE CONSTABULARY Request for Police Information Subject of Enquiries Address details: House Number/Name Street Town Postcode Tenancy details: ( (include details of whom premises shared with, children, d.o.b.’s etc) Location of Incident Details of Person of Interest: Full Name Date of Birth Gender Brief description of the nature of complaints being investigated: Please advise of any other information which might assist in identifying information relevant to this enquiry [please add continuation sheets as required]: Manager I confirm that I have reviewed this request and that I am satisfied that it is in accordance with the Information Sharing Agreement for Anti-Social Behaviour, to support specific action by this organisation under relevant Anti-Social Behaviour legislation. Name of Manager:
Name Telephone Number. Telephone call-backs may be made to each Issuer and Depositor if joint instructions are required pursuant to this Escrow Agreement. Schedule 3 Escrow Agent Fees: $1,000 - set-up fee payable in advance of the closing of the transaction $3,000 – annual administration fee covering up to 100 deposits, payable in advance of the closing of the transaction and upon each subsequent annual anniversary date. There is an additional administration fee of $750.00 for each block of 50 deposits over the initial 100 deposits. TRANSACTION FEES: Wire transfer of fund: $35.00/domestic wire initiated; $75.00/international payment Checks Cut: $10.00/check cut 1099 Preparation: $12.00/1099 prepared 1042-S Preparation: $50.00/per 1042-S Returned Check: $30.00/returned item An additional annual fee of 15 basis points on the escrow account balance payable in advance may be charged for investments other than institutional money market funds with which the Escrow Agent has established servicing arrangements. Out-of-pocket expenses, fees and disbursements and services of an unanticipated or unexpected nature are not included in the above schedule. EXHIBIT E 2018 STOCK INCENTIVE PLAN TFF PHARMACEUTICALS, INC. 2018 STOCK INCENTIVE PLAN
Name Telephone Number. 1. _________________________ _________________________ 2. _________________________ _________________________ 3. _________________________ _________________________ If to Fargo: 1. _________________________ _________________________ 2. _________________________ _________________________ 3. _________________________ _________________________ If to Shareholder Representative: 1.
