Attach Voided Check Sample Clauses

Attach Voided Check. V5. SCHEDULED PAYMENTS -------------------------------------------------------------------------------- You may select either ISA/EFT or MCB. ISA Number [ ] [ ] [ ] [ ] ELECTRONIC FUNDS TRANSFER (ISA/EFT) You must attach a voided check. Select one: [ ] MONTHLY [ ] QUARTERLY [ ] SEMI-ANNUALLY [ ] ANNUALLY Amount Date of First Draft | | |$ | __________________________________________________________________ Bank Transit Number Checking/Savings Account Number | | | | __________________________________________________________________ Bank Name [ ] CHECKING | [ ] SAVINGS | _____________________________________________ BANK ACCOUNT OWNER - Select one: [ ] ANNUITANT [ ] OTHER- Enter information below: Name: First, MI, Last Sex Birthdate: mm-dd-yyyy | | | | | | ______________________________________________________________________________ Street Address City, State, Zip | | | | ______________________________________________________________________________ Taxpayer ID Number Daytime Telephone Number | | | | ______________________________________________________________________________ Signature below is authorization to the depository institution specified above to pay and charge named account with electronic funds transfers, or other form of pre-authorized check or withdrawal order transfers, initiated by the Northwestern Mutual Life Insurance Company to its own order. This authorization will remain in effect until revoked in writing. X __________________________________________________________ Signature of Bank Account Owner [ ] MULTIPLE CONTRACT BILL (MCB) Amount MCB Number MCB Payer Name | | | |$ | | ______________________________________________________________________________ 47 -------------------------------------------------------------------------------- SIGNATURES - VARIABLE ANNUITY -------------------------------------------------------------------------------- THE ANNUITANT CONSENTS TO THIS APPLICATION. EACH PERSON SIGNING THIS APPLICATION DECLARES THAT THE ANSWERS AND STATEMENTS MADE IN THIS APPLICATION ARE CORRECTLY RECORDED, COMPLETE AND TRUE TO THE BEST OF HIS OR HER KNOWLEDGE AND BELIEF.
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Attach Voided Check. HERE (Neither a temporary check nor a deposit slip is acceptable.) For savings account, see “Savings Account” on the back of this form. White: Payroll Gold: Employee MIS 010 (06/09)
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Attach Voided Check. I hereby authorize the Los Angeles Police Federal Credit Union to initiate debit(s)/credit(s) (and/or corrections to the previous entries) to my account as indicated above. This authority will remain in full force and effect until I give LAPFCU written notification at least (3) business days prior to a scheduled transfer date. I agree that this account shall be governed by the terms and conditions of the LAPFCU Truth-in- Savings Disclosure and Agreement, and I acknowledge receipt of a copy of the Agreement. In addition, I agree to the following terms and conditions:
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Attach Voided Check. The Merchant agrees to abide by the terms & conditions contained in the Merchant Processing Agreement signed on , provided, however, that the term of the Merchant Processing Agreement relating to the above-referenced Additional Location shall be for the same length of time as the initial Term (defined in the Merchant Processing Agreement), and such Initial Term for the Additional Location shall commence on the date signed by Officer/Owner, indicated below.
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Attach Voided Check. Do Not Attach Deposit Slips.
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Attach Voided Check. The Merchant agrees to abide by the terms & conditions contained in the Merchant Processing Agreement signed on , provided, however, that the term of the Merchant Processing Agreement relating to the above-referenced Additional Location shall be for the same length of time as the initial Term (defined in the Merchant Processing Agreement), and such Initial Term for the Additional Location shall commence on the date signed by Officer/Owner, indicated below. Printed Officer/Owner Name Signature Title Date Legal Name: City of Richmond Bank Chain: 204622 Main Contact: Title: Accounting Manager Merchant Number: (Assigned Upon Approval) DBA: City of Richmond Web Location Address: 000 Xxxxx Xxxxxx Xxxxx Mailing Address: PO Box 4046 Customer Service Phone Number: (510) Main Contact: Statement DBA (23 Chr.): City of Richmond Web SIC: 0000 Xxxx: Xxxxxxxx XX: XX Zip: 00000 Xxxx: Xxxxxxxx XX: XX Zip: 94804 000-0000 Phone #: (000) 000-0000 Fax #: (000) 000-0000 Title: Accounting Manager Email: Avg Ticket: $451.00 Max: _ Monthly Vol: $123,180.00 Swipe % 0 Keyed % 0 MOTO % 0 Internet % 100 Merchant Products or Services Offered (be specific): City Tax and Permits Terminal / Payment Application: iMS Version: Does Merchant Use Independent Servicer (store, maintain, or transmits cardholder data)? (if yes, provide the following) Servicer / Payment App. Manufacturer: BridgePay / iMS Software Phone: American Express (10 Digits): American Express Annual Volume: Program: Service Fees: Account Name: AMS*Service Fee MID: 730308296 Rate: 2.95% Service Fee with a $2.00 minimum per transaction Merchant Type: Internet Website Building Type: Office Building Area Zoned Commercial Square Footage: 2501 - 5000 Merchant: Owns This Location is Open for Business: Yes No Inspected By: Date: Sell To: Business: 75 % Public: 25 % Locally Does the Merchant Own Product/Inventory? Orders Processed by: Merchant If Processing Internet Transactions (Please Complete The Following) Cards Processed by: Merchant Internet transactions encrypted by SSL or Better? YES
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Attach Voided Check. HERE (If withdrawing from a checking account):
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Attach Voided Check. Check box if this is a revision to a previous agreement. Attach voided check.
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Attach Voided Check. By signing this form, you are agreeing to the terms noted within this membership agreement. Print Student Name (Parent/Guardian if under 18yrs of age) Signature of Student Date A membership period is defined as one (1) month. Memberships are automatically renewed every month unless cancellation is provided at least thirty (30) days prior to your membership renewal period. Kinetix Combat Sports & Fitness reserves the right to change membership fee schedules at any time.
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Related to Attach Voided Check

  • Returned Check Charge A Customer whose payment by check is returned for insufficient funds, or is otherwise not processed for payment, will be subject to a returned check charge. Such charge will be applicable on each occasion when a check is returned or not processed. If the returned check was for a combined interstate and international balance, only a single returned check charge will apply.

  • Dishonored Checks The Transfer Agent may receive any fees reasonably related to the cost incurred by the Transfer Agent when a shareholder purchases shares by check and the purchase is subsequently canceled because the check was dishonored by the shareholder’s bank.

  • Background Check The Department or Customer may require the Contractor to conduct background checks of its employees, agents, representatives, and subcontractors as directed by the Department or Customer. The cost of the background checks will be borne by the Contractor. The Department or Customer may require the Contractor to exclude the Contractor’s employees, agents, representatives, or subcontractors based on the background check results. In addition, the Contractor must ensure that all persons have a responsibility to self-report to the Contractor within three (3) calendar days any arrest for any disqualifying offense. The Contractor must notify the Contract Manager within twenty-four (24) hours of all details concerning any reported arrest. Upon the request of the Department or Customer, the Contractor will re-screen any of its employees, agents, representatives, and subcontractors during the term of the Contract.

  • _CheckoutDate_ _CheckoutTime_ Rental $_Rental_ Fees $_Fees_ Taxes $_AreaTax_ Total $_NetAmount_ Security Deposit $_RefundableSecurityDeposit_ Deposit $_DepositAmount_ (due _DepositDueDate_) Balance $_BalanceAmount_ (due _BalanceDueDate_)

  • CONTRACT EXHIBIT I PREFERRED PRICING AFFIDAVIT This preferred-pricing affidavit is entered into in accordance with section 216.0113, F.S., and as required by Contract No. 80101507-21-STC-ITSA (“Contract”) between (“Contractor”) and the Department of Management Services. As the person authorized by Contractor to sign this affidavit, I attest that the Contractor is in full compliance with the preferred-pricing clause of the Contract. Contractor’s Name: By: Signature Printed Name/Title Date: STATE OF COUNTY OF Sworn to (or affirmed) and subscribed before me this day of , by Vendor Name: FEIN# Vendor’s Authorized Representative Name and Title: Address: City, State, and Zip code: Phone Number: ( ) - E-mail: CORPORATE SEAL (IF APPLICABLE) (Print, Type, or Stamp Commissioned Name of Notary Public) [Check One] Personally Known OR Produced the following I.D.

  • Returned Checks In the event that a check intended as payment for Rent is dishonoured for whatever reason, the same shall be considered as Late Rent with the late fee being payable on the same.

  • Background Checks The State may require that the Contractor and Contractor Parties undergo criminal background checks as provided for in the State of Connecticut Department of Emergency Services and Public Protection Administration and Operations Manual or such other State document as governs procedures for background checks. The Contractor and Contractor Parties shall cooperate fully as necessary or reasonably requested with the State and its agents in connection with such background checks.

  • Payment of Other Taxes by Xxxxxxxx The Borrower shall timely pay to the relevant Governmental Authority in accordance with Applicable Law, or at the option of the Administrative Agent timely reimburse it for the payment of, any Other Taxes.

  • License Contingent Upon Payment While you may exercise the rights licensed immediately upon issuance of the license at the end of the licensing process for the transaction, provided that you have disclosed complete and accurate details of your proposed use, no license is finally effective unless and until full payment is received from you (either by publisher or by CCC) as provided in CCC's Billing and Payment terms and conditions. If full payment is not received on a timely basis, then any license preliminarily granted shall be deemed automatically revoked and shall be void as if never granted. Further, in the event that you breach any of these terms and conditions or any of CCC's Billing and Payment terms and conditions, the license is automatically revoked and shall be void as if never granted. Use of materials as described in a revoked license, as well as any use of the materials beyond the scope of an unrevoked license, may constitute copyright infringement and publisher reserves the right to take any and all action to protect its copyright in the materials.

  • Criminal Background Check It is the Responsibility of CHESAPEAKE CENTER, INC. to make certain that its employees, agents, volunteers, and contractors, who have contact with students receiving services are fingerprinted and have a background check in compliance with Family Law Article, Annotated Code of Maryland, and Section 5-551 through 5-557. CHESAPEAKE CENTER, INC. may not hire, contract, or otherwise engage an individual to participate in this Cooperative Agreement who has been convicted of a crime involving child abuse or neglect; contributing to the delinquency of a minor; a crime of violence as set forth in Criminal Law Article §14-101, Annotated Code of Maryland; or has evidence of a criminal history which in the opinion of Chesapeake Center, Inc. makes the individual unfit to participate in this Cooperative Agreement.

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