NSF Fee. If a Non-Sufficient Funds (NSF) Fee is mentioned herein, and if it is greater than the amount permitted under Governing Law, the amount under Governing Law shall take precedent. If a Non-Sufficient Funds (NSF) Fee is charged to the Tenant, it shall be due and payable immediately.
NSF Fee. If any payment tendered by you is returned due to insufficient funds, you agree to immediately pay a fee of $50.00 in addition to any other fees we have incurred. Failure to pay this fee immediately shall be a material default and breach of this Agreement. If unpaid, the fee will be deducted from the security deposit at the termination of this Agreement.
NSF Fee. If any check tendered by Tenant is returned due to insufficient funds, the Tenant shall pay a fee of FIFTY DOLLARS ($50.00). This amount, if unpaid, may be deducted by Lessor’s Agent from the deposited amount pursuant to Paragraph #12 herein.
NSF Fee. If any check is dishonored for any reason, said late charges shall be due and payable in addition to a return check charge identified in the attached as an NSF Fee.
NSF Fee. If you present any type of payment instrument or method that is dishonored for any reason by the drawee, we may charge you a $10 fee in MA and a
NSF Fee. If the Tenant pays Rent or any other fee to the Landlord with a bad or returned check, there is: (check one) ☐ - No NSF Fee. ☐ - NSF Fee. (check one) ☐ - $[AMOUNT] ☐ - The maximum amount permitted under Governing Law or $50, whichever is greater.
NSF Fee. All payment returned due to non-sufficient funds will be subject to a NSF fee of $25.00 Thank you for understanding and accepting our Financial Policy. Please let us know if you have any questions or concerns. Patient or Guardian Signature Date Notice of information and Privacy Practices HIPAA Communication Form Patient Name: DOB: I have been given a copy of Professional Dental Alliance practice (“Practice”), Notice of Information and Privacy Practices (“Notice”), which describes how my health information is used and shared. I understand that the Practice has the right to change this Notice at any time. I may obtain a current copy by contacting the Privacy Officer at (000) 000-0000, or by visiting the Practice’s web site. Patient privacy is important to us. Our policy to keep patient health information confidential and not disclose such information without your consent or written authorization unless otherwise required by federal or state privacy laws. Please provide us with information with whom we can communicate with concerning your care. We would also like to obtain information regarding alternative communication preferences so that we know the best way to contact you with appointment reminders or other information related to your care. Please note: If you have someone accompany you in the treatment area, we will assume this person is entitled to receive information regarding your care and we can freely discuss your health information. You are free to make changes to your preferences at any time. Updates must be made in person and a new form completed. Please provide the names and relationship to patient for those individuals you will need or want your health information to be provided. This includes family members, friends, organizations or caregivers/babysitters: Name: Relationship: Name: Relationship: Name: Relationship: Name: Relationship: Patient Communication – Our practice is to protect the privacy of our patients while ensuring our patients are kept well informed of their appointments and other information. As a service to our patients, we will communicate appointment reminders and other information via text message, email or via phone. Limited information will be left when leaving a voice massage. Medical information will not be shared when leaving a voice message. Please inform our team if you would prefer we use an additional communication preference for appointment reminders or other information related to your care.
NSF Fee. If Occupant’s property is processed for sale at public auction, Occupant shall be responsible for a $30.00 Auction Certification Fee at ninety (90) days late Rent and a $60.00 Auction Advertising Fee seven (7) days before the scheduled auction. The Occupant shall pay all costs of collection, which includes collection agency fees and court costs. If Occupant’s lock must be cut, Occupant shall pay for a Lock Cut Fee of $35.00. Other fees charged to Occupant may be contained in Addendums to this Agreement.
NSF Fee. If the Tenant pays Rent or any other fee to the Landlord with a bad or returned check, there is: (check one)
NSF Fee. If you present any type of payment instrument or method that is dishonored by the drawee, we may charge you a fee of $15 in CA, $20 in UT, $25 in CO, LA, NV, NM & OK, $30 in TX, AR (after notice) & HI(after notice), and the greater of $10 or bank fee in AZ.
