Your Authorization. By accepting coverage under this Contract, You permit the Company to request any information related to a claim for services that You received and authorize that any information may be given to the Company regarding medical services You have received. This applies to all types of claims, including claims related to Medicare. If the Company asks for information and does not receive it, payment for covered services cannot be made. The claim will be processed for payment only when the requested information has been received and reviewed.
Your Authorization. You represent that You have full right and/or authorization to enter into this Agreement.
Your Authorization. If you do not agree to the terms and conditions in this Agreement, you may not complete the registration process. Checking the box entitled, "I have reviewed and agree to the terms and conditions contained in the Consumer Internet Agreement." and proceeding to use the Online Services services indicates your acknowledgement that you have read and accepted these terms and conditions. By making payments on your NEIF loan account through Online Services, you are authorizing NEIF to electronically charge your checking or savings account for the amount you submitted. If you want to use this method of payment, you must complete this authorization process each time. You will receive an email notification each month stating that your loan statement is available for online viewing and payment. You are not required by NEIF to authorize NEIF to make electronic charges to your checking or savings account as your method of payment. You may continue to make payments on your loan account through any other method acceptable to NEIF. If you wish to revoke your consent to monthly electronic loan statements, please contact Loan Servicing.
Your Authorization. By signing below, I authorize Mutual of Omaha to obtain and use consumer reports about me in order to evaluate my eligibility to contract with Mutual of Omaha as an insurance producer. If I do contract with Mutual of Omaha as an insurance producer, by signing below, I also authorize Mutual of Omaha to obtain and use consumer reports about me while my contract is in effect in order to evaluate my continued eligibility to remain an insurance producer for Mutual of Omaha. Candidate Signature Date Print Name Additional Information About Consumer Reports Consumer reports may include, among other things, information about your credit history, criminal record and history, and insurance department regulatory actions. We will obtain a copy of your consumer report from: Name/Address/Phone For California, Minnesota and Oklahoma: You have a right to request a copy of the consumer report which will disclose the nature and scope of the report. Yes, please provide me a copy of the consumer report For New York: You have a right, upon written request, to be informed of whether or not a consumer report was requested. If a consumer report is requested, you will be provided with the name and address of the consumer reporting agency furnishing the report. GENERAL AGENT AGREEMENT This General Agent Agreement (“Agreement”) is entered into between the undersigned General Agent (“GA”) and Mutual of Omaha Insurance Company, and each affiliated insurance company as specified on the Compensation/Product Schedule(s) attached to the Agreement (hereinafter referred to as the “Company”). The parties agree that additional affiliates of the Company may be added to the Agreement at a later date by way of changes/additions to the Compensation/Product Schedules attached hereto. Any Company affiliate added to the Agreement will be thereafter included in the definition of “Company”.
Your Authorization. In addition to our use of your health information for treatment, payment, or healthcare operations, you may give us
Your Authorization. You authorize us to hold, receive, and disburse funds on your behalf. Your authorization permits us to generate a paper draft or an electronic funds transfer to process each payment transaction that you authorize. The authorizations will remain in full force and effect until your StrongBox Account is closed and/or terminated.
Your Authorization. If you do not agree to the terms and conditions in this Agreement, you may not complete the registration process. Checking the box entitled, "I have reviewed and agree to the terms and conditions contained in the Consumer Internet Agreement." and proceeding to use the Online Services services indicates your acknowledgement that you have read and accepted these terms and conditions. By making payments on your Advantage Finance loan account through Online Services, you are authorizing Advantage Finance to electronically charge your checking or savings account for the amount you submitted. If you want to use this method of payment, you must complete this authorization process each time. You will receive an email notification each month stating that your loan statement is available for online viewing and payment. You are not required by Advantage Finance to authorize Advantage Finance to make electronic charges to your checking or savings account as your method of payment. You may continue to make payments on your loan account through any other method acceptable to Advantage Finance. If you wish to revoke your consent to monthly electronic loan statements, please contact customer service.
Your Authorization. If you do not agree to the terms and conditions in this Agreement, you may not complete the registration process. Checking the box entitled, "I have reviewed and agree to the terms and conditions contained in the Consumer Internet Agreement." and proceeding to use the Online Services services indicates your acknowledgement that you have read and accepted these terms and conditions. By making payments on your Xxxxxxxx Financial, Inc. loan account through Online Services, you are authorizing Xxxxxxxx Financial, Inc. to electronically charge your checking or savings account for the amount you submitted. If you want to use this method of payment, you must complete this authorization process each time. You will receive an email notification each month stating that your loan statement is available for online viewing and payment. You are not required by Xxxxxxxx Financial, Inc. to authorize Xxxxxxxx Financial, Inc. to make electronic charges to your checking or savings account as your method of payment. You may continue to make payments on your loan account through any other method acceptable to Xxxxxxxx Financial, Inc.. If you wish to revoke your consent to monthly electronic loan statements, please contact Xxxxxxxx Financial, Inc. customer service.
Your Authorization. Subject to this Agreement, you authorize us to hold, receive and disburse funds in accordance with your payment instructions, whether provided to us directly or through a Provider's Application, and whether to us in our own capacity or in our capacity as payment processor acting on behalf of sellers of goods or services and other third parties that have appointed us as agent for the limited purpose of receiving payments. Your authorization permits us (a) to debit or credit your Balance, a Bank Account, any credit card, debit card, or other payment cards that we accept ("Cards"), or any other payment method we accept, or (b) to process payment transactions that you authorize by generating a paper draft or an electronic funds transfer. Your authorizations will remain in full force and effect while you maintain your Payment Account with us and for any Bank Account.
Your Authorization. If you do not agree to the terms and conditions in this Agreement, you may not complete the registration process. Checking the box entitled, "I have reviewed and agree with the Agreement listed above" and proceeding to use the Online Services indicates your acknowledgement that you have read and accepted these terms and conditions. By making payments on your First Metropolitan loan account through Online Services, you are authorizing First Metropolitan to electronically charge your checking account, savings account, or debit card for the amount you submitted. If you want to use this method of payment, you must complete this authorization process each time. You will receive an email notification each month stating that your loan statement is available for online viewing and payment. You are not required by First Metropolitan to authorize FMFS to make electronic charges to your checking account, savings account, or debit cards your method of payment. You may continue to make payments on your loan account through any other method of payment acceptable by First Metropolitan. If you agreed to terminate receipt of a monthly paper loan statement and accept presentation of a monthly electronic loan statement, you do not need to do anything further. If you wish to revoke your consent to monthly electronic loan statements; log on to Online Services, select the E-statement menu item and Set Statement Preferences. Then change your delivery preference from Electronic to Paper.
