Business Telephone No. Is this an Agreement Renewal: Yes No The following persons will participate in one or more litter pick-ups. As indicated by their signatures on this agreement, the individual participants are aware of the potentially hazardous nature of the work which is to be performed and agree to follow the TERMS AND CONDITIONS of the Town ADOPT-A-ROAD PROGRAM and agree not to hold the Corporation of the Town of Penetanguishene responsible for any injuries or any damages that they may cause or suffer as a result of participation in the program and agree that signs bearing the individual group name shall be installed solely at the discretion of the Town. Youths (18 years of age and under) involved in the program must have signed permission from a parent or guardian (19 years of age or older). Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date Name (print) Signature Date (Attach a second (or more) sheets for additional participant names and signatures to the end of this Agreement.)
Business Telephone No. (Area Code) and No. ( ) ( ) -------------------------------------------------------------------------------- Driver's License Information No. State -------------------------------------------------------------------------------- The best time for us to call you is 1st Choice ____________ Eastern at |_| Home |_| Business 2nd Choice ____________ Time -------------------------------------------------------------------------------- Agency Agent Date Received in P.H.I.
Business Telephone No. Firm Address City State Zip If the financial advisor ceases to be affiliated with Xxxxxxx Xxxxx, or does not maintain the necessary regulatory registration to service Client’s Account(s), Xxxxxxx Xxxxx xxx appoint another duly registered financial advisor to service this RJCS Agreement. In such an event, the Manager and AMS will continue to effect transactions for the Account(s) through RJA until Client instructs otherwise.
Business Telephone No. ( ) Mobile Phone Number Email Address Contact Person (regarding this application) Position Title of Key Contact Builder’s Insurance Agent Builder’s Intermediary Intermediary Contact Name Intermediary Reference Intermediary Telephone Number Intermediary Email Address ( ) Unit Number Lot Number or Street No. Stree Name Suburb Postcode Project Description Building Contract Price (Inc GST) $
Business Telephone No. Business Fax No. Years Business Established? Years Months CREDIT AMOUNT REQUESTED 5. We are engaged in Business of: A/P EMAIL ADDRESS 🗆 SOLE PROPRIETOR 🗆 PARTNERSHIP 🗆 CORPORATION 🗆 LLC 6. CONTRACTORS LICENSE NO. STATE ISSUED A/P CONTACT NAME PHONE BUSINESS BUILDING IS 🗆 OWNED 🗆 RENTED OWNERS (IF APPLICANT IS A SOLE PROPRIETOR OR PARTNERSHIP) OFFICERS (IF CORPORATION) 7. NAME TITLE HOME ADDRESS HOME PHONE NO.
Business Telephone No. Business______________________ Home__________________________ Home__________________________ ---------------------------------------------------- ---------------------------------------------------------
Business Telephone No. WE ARE ENGAGED IN THE BUSINESS OF: MONTHLY STATEMENT □ YES □ SOLE PROPRIETOR □ ZIP NO. OF EMPLOYEES CORPORATION 5. OF ACCOUNT REQUIRED? □ NO □ PARTNERSHIP □ LLC STATE ISSUED CONTRACTOR’S LICENSE NO. 6. BUSINESS BUILDING IS A/P CONTACT NAME FAX NUMBER □ OWNED □ RENTED NAME 7. TITLE HOME ADDRESS HOME PHONE NO. NAME 8. TITLE HOME ADDRESS HOME PHONE NO. NAME 9. TITLE HOME ADDRESS HOME PHONE NO. NAME 10. BRANCH ADDRESS ACCOUNT NO. TYPE OF ACCOUNT NAME 11. BRANCH ADDRESS ACCOUNT NO. TYPE OF ACCOUNT NAME 12. ADDRESS, CITY, STATE & ZIP PHONE NUMBER AMOUNT OWING NAME 13. ADDRESS, CITY, STATE & ZIP PHONE NUMBER AMOUNT OWING NAME 14. ADDRESS, CITY, STATE & ZIP PHONE NUMBER AMOUNT OWING NAME 15. ADDRESS, CITY, STATE & ZIP PHONE NUMBER AMOUNT OWING
