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.
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)
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:
Attach Voided Check. HERE (If withdrawing from a checking account):
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: ▇▇▇ ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇ Mailing Address: PO Box 4046 Customer Service Phone Number: (510) Main Contact: Statement DBA (23 Chr.): City of Richmond Web SIC: ▇▇▇▇ ▇▇▇▇: ▇▇▇▇▇▇▇▇ ▇▇: ▇▇ Zip: ▇▇▇▇▇ ▇▇▇▇: ▇▇▇▇▇▇▇▇ ▇▇: ▇▇ Zip: 94804 ▇▇▇-▇▇▇▇ Phone #: (▇▇▇) ▇▇▇-▇▇▇▇ Fax #: (▇▇▇) ▇▇▇-▇▇▇▇ 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
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.
Attach Voided Check. Do Not Attach Deposit Slips.
Attach Voided Check. Check box if this is a revision to a previous agreement. Attach voided check.
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.