Evening Telephone Number Sample Clauses

Evening Telephone Number. Email address (E-mail address is not required, but if you provide it you authorize the Claims Administrator to use it in providing you with information relevant to this claim.): Name of the Person you would like the Claims Administrator to Contact Regarding this Claim (if different from the Claimant Name(s) listed above:
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Evening Telephone Number. Email Address Social Security Number Date of Birth (month | day | year) Percentage Share Relationship to Participant Participant understands that, if no beneficiary survives the Participant, the Participant’s estate will be the sole beneficiary for the Account. Participant understands that, if Participant fails to indicate share percentages, all benefits will be divided equally among the primary beneficiaries (or contingent beneficiaries, if no primary beneficiary remains). Participant understands that the Participant may change or revoke this designation at any time by completing a new Beneficiary Designation form during the Participant’s lifetime with Aspire. It will become effective when Aspire receives it. Completion of this form will revoke any prior beneficiary designations made for the account. If Participant does not designate his/her spouse as the sole Primary Beneficiary, Participant represents and warrants that the Participant’s spouse has consented to such designation. Spousal Waiver: By signing below, the spouse of the Participant acknowledges (1) that he/she is the spouse of the Participant; (2) that he/she has received a fair and reasonable disclosure of the Participant’s property and financial obligations; (3) that he/she has been advised to see a tax professional due to the important financial and tax consequences of giving up his/her interest in the Account; and (4) that neither Aspire nor the custodian of the Account has provided the Participant’s spouse with any tax, legal, or investment advice. By signing below, the spouse of the Participant hereby gives the Participant any interest the spouse has in the assets of the Account; consents to the beneficiary designations indicated above; and assumes full responsibility for any adverse consequences that may result. Spouse Name Participant Signature Date (month | day | year) Notary Name County State Commission Expiration Date (month | day | year) Notary Seal Notary Signature Signed before me Date (month | day | year) STEP 3
Sample 1
Evening Telephone Number. A Life Time Department Manager or General Manager may withdraw Minor Participant from participating in the Programs as a final disciplinary option, or because of a Minor Participant’s illness or injury. After removing Minor Participant for such a reason, Life Time will supervise Minor Participant until an authorized adult is able to sign such child out of Life Time’s care.
Sample 1

Related to Evening Telephone Number

  • Toll-Free Telephone Number A contractor located outside of San Francisco is encouraged to provide free telephone services for placing orders. This requirement can be met by providing a toll-free telephone number or accepting collect calls. The free service will be a consideration in evaluating this bid.

  • Vendor Telephone Number Self explanatory. (Agency specific) 1d. Vendor E-mail Address - Self explanatory. (Agency specific) 2a. Course Title - Insert the title of the course or the program that the employee is scheduled to complete.

  • Telephone Number Consumer Credit Associates, Inc. Call (000) 000-0000, either extension 000 Xxxxxxxxxxxx Xxxxxx, Xxxxx 000 150, 101, or 112, for all inquiries. Xxxxxxx, Xxxxx 00000-0000 Equifax Members that have an account number may call their local sales representative for all inquiries; lenders that need to set up an account should call (000) 000-0000 and select the customer assistance option. TRW Information Systems & Services Call (000) 000-0000 for all inquiries, 000 XXX Xxxxxxx current members should select option 3; Xxxxx, Xxxxx 00000 lenders that need to set up an account should select Option 4. Trans Union Corporation Call (000) 000-0000 to get the name of 555 West Xxxxx the local bureau to contact about setting Xxxxxxx, Xxxxxxxx 00000 up an account or obtaining other information.

  • Office Telephone Number Insert the employee's area code, office telephone number and extension.

  • Home Telephone Number Employee's area code, home telephone number.

  • Phone Number Email address .................................................................

  • Telephone Numbers Customer Service and Preauthorization: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Appeals: 000-000-0000 Preauthorization and notification for Behavioral Health services: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Home Delivery (Mail Order): 0- 000-000-0000 Preauthorization: 0-000-000-0000 Customer Service: In state: 000-000-0000; Out of state: 0-000-000-0000; Hearing impaired: 711 Customer Service and Appeals: 0-000-000-0000 Website: xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx xxx.xxxxxx.xxx Fax: Appeals: 000-000-0000 Preauthorization and Appeals: 0-000-000-0000 Not Applicable Appeals: 0-000-000-0000 Mailing address to file a claim: Blue Cross & Blue Shield of Rhode Island Claims Department 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. P.O. Box 21870 Lehigh Valley, PA 18002-1870 Blue Cross & Blue Shield of Rhode Island Dental Claims Administrator P.O. Box 69427 Harrisburg, PA 17106-9427 Blue Cross Vision c/o EyeMed Vision Care Attn: OON Claims P.O. Box 8504 Mason, OH 45040-7111 Mailing address to submit an appeal: Blue Cross & Blue Shield of Rhode Island Grievance and Appeals Xxxx 000 Xxxxxxxx Xxxxxx Xxxxxxxxxx, XX 00000 Prime Therapeutics, LLC. Clinical Review Dept. 0000 Xxxxxxxxx Xxxxxx Xxxxx Xxxxx, XX 00000 Blue Cross & Blue Shield of Rhode Island Dental Customer Service – Appeals P.O. Box 69420 Harrisburg, PA 17106-9420 EyeMed Vision Care Attn: Quality Assurance Dept. 0000 Xxxxxxxxx Xxxxx Xxxxx, XX 00000 BCBSRI Customer Service Department Call Center hours are: • Monday thru Friday 8:00 AM to 8:00 PM • Saturday thru Sunday 8:00 AM to 12:00 PM Your Blue Store You may also visit one of our retail walk-in service centers. Please check our website for specific locations and business hours.

  • Access to Telephone Numbers Carrier is responsible for interfacing with the North American Numbering Plan administrator for all matters dealing with dedicated NXXs. BellSouth will cooperate with Carrier in the provision of shared NXXs where BellSouth is the service provider.

  • Telephone No ( ) - Fax No.: ( ) - E-mail Address: IN WITNESS WHEREOF, two (2) identical counterparts of this instrument, each of which shall for all purposes be deemed an original thereof, have been duly executed by the Principal and Surety above named, on the day of , 20 . Principal (Name of Principal) (Signature of Person with Authority) (Print Name) Surety (Name of Surety) (Signature of Person with Authority) (Print Name) (Name of California Agent of Surety) (Address of California Agent of Surety) (Telephone Number of California Agent of Surety) Contractor must attach a Notarial Acknowledgment for all Surety's signatures and a Power of Attorney and Certificate of Authority for Surety. The California Department of Insurance must authorize the Surety to be an admitted surety insurer. PAYMENT BOND PAYMENT BOND -- Contractor's Labor & Material Bond (100% of Contract Price) (Note: Contractors must use this form, NOT a surety company form.) KNOW ALL PERSONS BY THESE PRESENTS:

  • Telephone Service Notwithstanding any other provision of this Lease to the contrary:

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