Client Contact Information. Please provide the Contact Information for those involved in the administration of your plan. Name: Title: Phone: Fax: Email: Primary Contact for: Implementation Case Management Privacy officer HR/Benefit manager Executive Web portal Eligibility Billing Claims Funding Additional Contact for: Implementation Case Management Privacy officer HR/Benefit manager Executive Web portal Eligibility Billing Claims Funding (continued) Name: Title: Phone: Fax: Email: Primary Contact for: Implementation Case Management Privacy officer HR/Benefit manager Executive Web portal Eligibility Billing Claims Funding Additional Contact for: Implementation Case Management Privacy officer HR/Benefit manager Executive Web portal Eligibility Billing Claims Funding Name: Title: Phone: Fax: Email: Primary Contact for: Implementation Case Management Privacy officer HR/Benefit manager Executive Web portal Eligibility Billing Claims Funding Additional Contact for: Implementation Case Management Privacy officer HR/Benefit manager Executive Web portal Eligibility Billing Claims Funding
Client Contact Information. The contact information of Client(s) is set forth below:
Client Contact Information. Please fill out the following information, which will be used by our deployment & accounting teams.
Client Contact Information. The contact information of Client(s) is set forth below: Client Name Address for Receiving Notice Business Telephone: Home Telephone: Cell Phone: Facsimile Number: E-mail Address: Client Name Address for Receiving Notice Business Telephone: Home Telephone: Cell Phone: Facsimile Number: E-mail Address: Client agrees to immediately update Broker of any changes to the above referenced information.
Client Contact Information. The Contact Person is the person within the Client organization who is selected by the Client to authorize user access to Employer Online Services. Contact Person: Contact Telephone Number: Contact E-mail Address:
Client Contact Information. Please fill out the following information, which will be used by our deployment & accounting teams. Address 000 Xxxxxxx Xx City, State Zip Carrollton, KY 41008
Client Contact Information. The contact information of Client(s) is set forth below: _________________A_m__e_ri_s_B_a_n_k_________________ Business Telephone: Client Name _________________________________________ Address for Receiving Notice _________________________________________ Home Telephone: Cell Phone: _________________________________________ Facsimile Number: _________________________________________ E-mail Address: _________________________________________ Client Name _________________________________________ Address for Receiving Notice _________________________________________ Business Telephone: Home Telephone: Cell Phone: _________________________________________ Facsimile Number: _________________________________________ E-mail Address: Client agrees to immediately update Broker of any changes to the above referenced information. No. Xx XxXxxxxx for Ameris Bank Form B-10 Xxx 00 Xxxxx Xxxxxxx Xxxx, Waverly GA 31565 WE ARE REPRESENTING OUR CLIENT IN THE MOST PROFESSIONAL MANNER AND HAVE LISTED BELOW STANDARDS TO FOLLOW.
I. TOP GOALS:
1. Fast Sales at the highest prices 2. Maintain good curb appeal- with minimal repairs
3. Sales are generally: “AS IS WHERE IS”
4. Minimum Sales Call response time is 1 hour
5. Professional and courteous service levels
II. COMMISSIONS and TERMINATION
1. Commissions are at 6% with .75% of the purchase price as a referral fee to Crown Realty Advisors.
2. Standard Listing is for 90 days.
3. Client maintains option to void listing at any time for any reason.
4. Client retains option to bulk sale and may pay up to $150 fee per listing or group asset listing to broker.
5. All communication is to be direct to Crown Realty Advisors, et al.
III. WITHIN 48 HOURS OF LISTING
1. Listing Set Up (Form Series B) a. BPO within 24 hours- use attached form
Client Contact Information. CLIENT shall provide a valid, confidential FAX number on the standard PATHGROUP Provider Fax Verification Form.
Client Contact Information. On or prior to the Effective Date, Client shall provide to gMed Client’s contact information and designate a contact person. If Client’s contact person or contact information changes at any time during the Term, Client shall, no later than five (5) business days prior to such change, provide notice of Client’s new contact person or contact information to gMed in writing.
Client Contact Information. Please fill out the following information, which will be used by our deployment & accounting teams. Address 0000 Xxxxxx Xxxxxx Xxxx City, State Zip Woodland Hills, CA 91367
