Credit Card Payment Information. Annual fees are based on the acreage of certified crops in a 12-month period and depend on which GlobalGAP standard you are enrolling in. Please contact CCOF directly so we may access your fees. Type of Credit Card: Visa Master Card Amex Amount: $ Credit Card Billing Address: City: State: Zip code: Name on Card: Email Address: Phone Number: Credit Card Number: Expiration Date (mm/yy): / Security Number (The three-digit code on the back of your card. For Amex, this is the four digits on the front): Signature: Operation Name: Date: Certification Contract and Agreement ► The following must be signed by a legally authorized representative of the legal entity seeking GLOBALG.A.P. certification with CCOF. By signing this document, the applicant acknowledges that it has received, has read, fully understands, and agrees to be bound by the CCOF CS Certification Manuals and agrees to: Be legally bound by and comply with the requirements set forth in the CCOF GLOBALG.A.P. Certification Program and Certification Services Program manuals. Comply with and strictly adhere to all CCOF standards, procedures and policies described in the CCOF Manuals including but not limited to the following: Permitting on-site inspections with complete access to the production or handling aspects of the operation, including non-certified production areas, structures, or offices; including examining documents, records, personnel and client's subcontractors and any investigation of complaints. These inspections may be announced or unannounced at the discretion of CCOF or as required by an accreditation authority, government entity with jurisdiction, or other governing body. Maintaining all records applicable to the organic operation for not less than five (5) years beyond their creation. When sending copies of certification records to others, the documents shall be reproduced in their entirety or as specified by CCOF CS. Allowing authorized representatives of CCOF, an accreditation authority, government entity with jurisdiction, or other governing body access to these records under normal business hours for review and copying to determine compliance with the applicable standards, regulations or governing law. Understanding CCOF may use subcontractors for inspecting, testing and other technical services, as necessary. Submitting to CCOF any applicable fees as described on the most current fee schedule or as included in the quo...
Credit Card Payment Information. College of Physicians and Surgeons of Nova Scotia fees can be paid in the following ways: - Cheque or money order - Cash (if paying in person) - Credit Card (VISA and Master Card only) - Visa Debit * Cheques returned by the bank for non-processing will be charged an administration fee. Replacement payments must be made by money order, certified cheque or cash and include the administration fee. Refer to the College’s website for the fee schedule. IF YOU ARE PAYING BY CREDIT OR DEBIT CARD, PLEASE COMPLETE AND SUBMIT THE FOLLOWING FORM: VISA VISA DEBIT MASTERCARD Amount of Payment: $ Credit Card Number: Expiry: Cardholder’s name as it appears on the card: _ (please print) Signature of Cardholder: Please indicate who this payment is for if not for the card holder FOR OFFICE USE ONLY: Physician Other Received by: Date: For: Processed by: Date: Receipt issued by: Date: Receipt # Breakdown of fees: Amount Code X:\Data\Registration Dept\Forms & Certificates\Credit Card Form - 2017.docx Consent for Release of Information What You Need to Know about MINC Numbers A medical identification number system has been developed with the goal of providing a reliable means of identifying every individual in the Canadian medical education and practice systems. A not-for-profit corporation (whose legal name is noted above), known as “MINC#NIMC”, has been incorporated by the Federation of Medical Regulatory Authorities of Canada (FMRAC) and the Medical Council of Canada (MCC) for the sole purpose of administering the MINC number system. A MINC number will be issued to all individuals (who consent in writing) at the time of their initial, even temporary, entry to any aspect of the Canadian medical education or practice systems, including undergraduate students, postgraduate trainees, applicants to the MCC examinations, and physicians of any registration status. Once assigned, an individual’s MINC number will remain unchanged throughout his/her entire medical career. Assigned numbers will never be reused, even after the death of the individual. Individuals will carry the same MINC number, even if they leave Canada and return, move between jurisdictions or change registration status. No information is encoded in an individual’s MINC number, other than a country code (CA for Canada) and a profession code (MD for Medicine). The MINC number does not imply any special privilege, rights or status; it is simply a series of letters and numbers for identification purposes. Upon t...
Credit Card Payment Information. Western Medical Equipment accepts Visa, Master Card, American Express, and Discovery for credit card payments. Cardholder Name Payment For (Customer Name) Billing Address Phone E-mail Send Receipt Here Total Amount $ Tax Exempt Credit Card Number Visa MC Amex Disc Expiration Date Security Code Signature Card member agrees to pay total in accordance with agreement governing use of such card. *Credit card and address information is confidential and will not be used for any other purpose other than is outlined in the Rental Agreement.
Credit Card Payment Information. Name on Card: Card Number: Expiration Date: 3-digit Security Code: Credit Card Address: Zip Code: Credit Card Phone Number: Driver’s License # This payment authorization is valid and to remain in effect until I have returned the Equipment and it has been determined by MCR Medical Supply, Inc. in its sole discretion to satisfy the conditions of this Agreement and Exhibit A.
