FORMS FEES Sample Clauses

FORMS FEES a. Medical record copies – Medical record copy requests made by the patient for their personal use, for an insurance company, an attorney, etc., will incur a copying fee, as directed by the state statute and are as follows, following the completion of a release of medical records form: $25.00 for the first 20 pages $.15 per page for additional pages over 20 $25.00 for Billing Records There is no charge for records being released to another physician.
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FORMS FEES a. Medical record copies – Medical record copy requests made by the patient for their personal use, for an insurance company, an attorney, etc., will incur a copying fee, as directed by the state statute, following the completion of a release of medical records form. There is no charge for records being released to another physician.
Sample 1

Related to FORMS FEES

  • FORMS OF PAYMENT Landlord agrees to accept the following forms of payment for the Rent: __________________________________________________________________________________ DELIVERABLE: Payment may be sent or delivered to the address noted below or to any person or institution denoted by Landlord, whether by mail, email or any other means. If payment shall be made electronically, the address below shall be utilized as Tenant's contact point for Landlord: ___________ __________________________________________________________________________________ The email address for landlord is as follows: ____________________________________________________

  • Alternative Forms of Notice Any notice or request required or permitted to be given by a Party to the other Parties and not required by this Agreement to be given in writing may be so given by telephone, facsimile or email to the telephone numbers and email addresses set out in Appendix F hereto.

  • Forms of Cooperation Development cooperation may take the form of technical or financial cooperation, humanitarian or emergency assistance. It may be carried out either on a purely bilateral basis, or also in cooperation with other donors and/or multilateral organisations.

  • ATM Fees If you use an ATM to obtain a cash advance and the ATM is not operated by us, you may be charged an ATM surcharge by the ATM operator or an ATM network utilized for such a transaction. The ATM surcharge may be charged to your account if you complete the transaction.

  • Forms of Discipline ‌ Discipline includes oral and written reprimands, reduction in pay, suspension, demotion, and discharge.

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  • Micropayments Fees You may qualify to receive micropayments pricing for the sale of goods and services through your PayPal account, if your transactions typically average less than $10. In order to qualify, you must have a PayPal account that is in good standing (for example, no limitations or negative PayPal balance), you may not be processing payments using PayPal Payments Pro and you must submit an application and have it approved by us. If your PayPal account is approved to accept micropayments, then the fees found on the Micropayment Fees table will apply to all transactions for the sale of goods or services processed through your PayPal account, instead of Merchant Services Fees. If you have multiple PayPal accounts, you must route your micropayments transactions through the appropriate account. Once a transaction is processed, PayPal will not re-route the transaction through a different account. PayPal Payouts If you are using PayPal Payouts (formerly Mass Pay), the terms of the PayPal Payouts Agreement will apply. Your responsibility to notify PayPal of pricing or fee errors Once you have access to any account statement(s) or other account activity information made available to you by PayPal with respect to your business account(s), you will have sixty (60) days to notify PayPal in writing of any errors or discrepancies with respect to the pricing or other fees applied by PayPal. If you do not notify PayPal within such timeframe, you accept such information as accurate, and PayPal shall have no obligation to make any corrections, unless otherwise required by applicable law. For the purposes of this provision, such pricing or fee errors or discrepancies are different than unauthorized transactions and other electronic transfer errors which are each subject to different notification timeframes as set forth in this user agreement.

  • TAXES/FEES Contractor promptly shall pay all applicable taxes on its operations and activities pertaining to this Master Contract. Failure to do so shall constitute breach of this Master Contract. Unless otherwise agreed, Purchaser shall pay applicable sales tax imposed by the State of Washington on purchased goods and/or services. Contractor, however, shall not make any charge for federal excise taxes and Xxxxxxxxx agrees to furnish Contractor with an exemption certificate where appropriate.

  • Form of Payments All payments to Holders will be made as Automated Clearing House (ACH) deposits into an account designated by each Holder at the Site.

  • SaaS Fees You agree to pay us the SaaS Fees. Those amounts are payable in accordance with our Invoicing and Payment Policy. The SaaS Fees are based on the number of Defined Users and amount of Data Storage Capacity. You may add additional users or additional data storage capacity on the terms set forth in Section H(1). In the event you regularly and/or meaningfully exceed the Defined Users or Data Storage Capacity, we reserve the right to charge you additional fees commensurate with the overage(s).

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