Checking Account Savings Account. This authority is to remain in full force and effect until final and full payment of amounts due on the underlying loan(s) is received, or until Vermont Housing Finance Agency has received written notification from me of its termination in such time and in such manner as to afford Vermont Housing Finance Agency a reasonable opportunity to act on it. Date: Signed: Please Print Name: Title: Accounting Contact: _ Telephone # Email Address: Please mail form to: VHFA P.O. Box 408 Burlington, VT 05402-0408 For VHFA use only: VHFA # Project # Maturity date Issue Series
Checking Account Savings Account. (select one) indicated below at the FINANCIAL INSTITUTION named below, and to debit the same from such account. I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law. FINANCIAL INSTITUTION (your bank) Name Branch City State Zip Routing Account Number Number Debits will only be made either ONCE – on the first regular banking day after the 1st Sunday or on the first regular banking day after the 3rd Sunday OR TWICE – on the first regular banking day after the 1st Sunday AND on the first regular banking day after the 3rd Sunday. Please indicate your choice: Start Date once a month $ amount begin-month or mid-month twice a month $ amount each time If you want your contribution, or any part of it, to go to an account other than the General Fund, please indicate that here . This authorization is to remain in full force and effect until FLC has received written notification from me (or either of us) of its termination in such time and in such manner as to afford FLC and FINANCIAL INSTITUTION a reasonable opportunity to act on it. Name(s) Faith Envelope Number (please print) Date Signature(s) Please attach a voided check or savings account deposit slip to this signed form. If you want your savings account used, please verify the routing number with your banking institution, as some banks use a different routing numbers for checking and savings accounts. When your form has been processed you will receive an acknowledgement from Xxxx Xxxxxxx. Form received at FLC by Date
Checking Account Savings Account. (attach a voided check) (attach routing & account # from your financial institution)
Checking Account Savings Account. This authority shall remain in effect until terminated by written notice by either Plan Participant or CITGO. Effective date of termination will be fifteen (15) days after receipt of written notice. Notice of termination shall in no way affect debit/credit entries initiated by CITGO prior to actual receipt of notice. In the event that there is a bank processing charge due to insufficient funds, Plan Participant agrees to be responsible for all costs associated with these items. CITGO will be responsible for all costs associated with delivery of debits/credits to Plan Participant’s bank. PLAN PARTICIPANT AUTHORIZATION I do certify that I have the full capacity and authority to so authorize and direct. DATE PLAN PARTICIPANT SIGNATURE FOR OFFICE USE ONLY EFFECTIVE DRAFT DATE BENEFITS AREA
Checking Account Savings Account. This authority is to remain in full force and effect until the Community and the Financial Institution have received written notification from me of its termination in such time and manner as to afford the Community and the Financial Institution a reasonable opportunity to act upon the request. I further understand that payments will be deducted from my account between the first and fifteenth day in which the assessment is due, and should my payment be returned for any reason, I understand that I can be terminated from the program and I will be charged a $25.00 administrative fee.
Checking Account Savings Account. This authorization is to remain in full force and effect until COMPANY has received written notification from me (or termination by COMPANY) in such time and in such manner as to afford COMPANY and DEPOSITORY a reasonable amount of time to act upon it. Name: (Please Print) Signature: Date: Email address: NOTE: Please attach a check to this form and write VOID on the signature line of the check. Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-9 OMB No. 1615-0047 Expires 08/31/2019 ►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. U.S. Social Security Number - - Employee's Telephone Number Employee's E-mail Address Date of Birth (mm/dd/yyyy) ZIP Code State City or Town Apt. Number Address (Street Number and Name) Other Last Names Used (if any) Middle Initial First Name (Given Name) Last Name (Family Name)
Checking Account Savings Account. This authorization is to remain in full force and effect until SPPS has received written notification from me (or either of us) of its termination in such time and in such manners as to afford SPPS a reasonable opportunity to act on it or until contract is complete. Name: Signature: Date: (Please Print) WITHDRAWAL PROCESS AND RELATED TUITION PAYMENTS Enrollment for the next academic year will occur automatically and families will be responsible for tuition according to the withdrawal schedule below: If your child withdraws from SPPS to attend another school within the district, tuition and fees will be forfeited. If the parent is paying tuition each month, he/she is responsible for paying the remainder of tuition and fees within the semester the student withdraws. If a child enrolled at SPPS withdraws from school due to moving/transfer out of this school district, no tuition or fees will be refunded; however, the parent will not be responsible for paying the remainder of the semester’s tuition. Tuition reimbursement for early withdrawal may be considered in cases of extreme medical or personal hardship. It is the family’s responsibility to complete a Notification of Withdrawal Form. The form is available in the school office and online at xxxxx://xxxxxxxxxxx.xxx. If you withdraw your child after your first tuition draft but before the first day of school, tuition payments will be refunded minus a $100 processing fee. A Notice of Withdrawal Form must be completed. If a Notice of Withdrawal Form is not completed by the first day of school, any tuition payments already made will be forfeited.
Checking Account Savings Account. It is the COMPANY’S responsibility to ensure the accuracy of the above information. Payments returned to PAYOR due to inaccuracy of information on the COMPANY’S part will result in delay of payment up to 3 weeks. This authorization is to remain in full force and effect until PAYOR has received written notification from me (or either of us) of its termination in such time and in such manner as to afford PAYOR and DEPOSITORY a reasonable opportunity to act on it. Name and Title (please print) Email address where electronic statements should be sent: Signature Date
