PLEASE COMPLETE THE FOLLOWING. If awarded a contract for this CDBG funded project, do you anticipate being able to determine employees’ hourly wages and addresses? Yes 🞏 No 🞏 If yes, please estimate the number of hours to be completed on the project by all workers:
PLEASE COMPLETE THE FOLLOWING. The undersigned hereby represents and warrants to the Company that the answers to the following questions are true and correct and that the Company may rely on such answers in deciding whether to accept this subscription.
PLEASE COMPLETE THE FOLLOWING. 1. If the exercise of this Warrant was solicited by Xxxxxx Xxxxxxxxx Wise & Company, please check the following box. |_|
2. The exercise of this Warrant was solicited by ---------------------------------------------------------------
3. If the exercise of this Warrant was not solicited, please check the following box. |_|
PLEASE COMPLETE THE FOLLOWING. 1. If the exercise of this Warrant was solicited by National Securities Corporation please check the following box [ ]
2. The exercise of this Warrant was solicited by [ ] --------------------------
3. If the exercise of this Warrant was not solicited, please check the following box [ ] Dated: ______________________ X____________________________ ____________________________ ____________________________ Address ____________________________ Social Security or Taxpayer Identification Number ____________________________ Signature Guaranteed
PLEASE COMPLETE THE FOLLOWING. 1. If the exercise of this Warrant was solicited by Network 1 Financial Securities, Inc.[] or Century City Securities, Inc.,[] please check the appropriate box.
2. The exercise of this Warrant was solicited by _______________________________________________________________
3. If the exercise of this Warrant was not solicited, please check the following box. / /
PLEASE COMPLETE THE FOLLOWING. (a) The Business Day on which such Loan is to occur is __________, 2013.
(b) The interest rate being selected in respect of such Loan shall initially bear interest at (check one (1) applicable box): [ ] LIBOR Rate plus the Applicable Margin [ ] Prime Rate plus the Applicable Margin
(c) The payment instructions/wire instructions for the delivery of such Loan is as follows: ________________________ ________________________ ABA No.:________________ Account No.:_____________
PLEASE COMPLETE THE FOLLOWING. 1. The exercise of this Warrant was solicited by May Xxxxx Group, Inc. o
2. The exercise of this Warrant was solicited by __________________________________. o
3. If the exercise of this Warrant was not solicited, please check the following box. o Dated:_________________199____ X_____________________________ ______________________________ ______________________________ Address ______________________________ Social Security or Taxpayer Identification Number ______________________________
PLEASE COMPLETE THE FOLLOWING. Has the Company or any of its Authorised Representatives or other representatives had a request for media accreditation (whether issued by DataCo or any other entity) declined, suspended or withdrawn? If “Yes”, please provide further details. Yes No
PLEASE COMPLETE THE FOLLOWING. (Caretaker will prepare facility per information supplied)
1. Number of people:
a. attending the meal
b. attending the function
2. Do you require:
a. Full Hall
b. P.A. System
c. Kitchen
d. Kitchen/Lobby
e. Lobby/Former Ice Surface
3. Date and time(s) prior to the function: (i.e. decorating, bar supplies, caterers,
a. Purpose: Time in: Time out:
b. Purpose: Time in: Time out:
4. The actual date and time required for your function:
a. Rental Day 1, Date:
i. Time in (doors open to public):
ii. Time out (doors locked):
b. Rental Day 2, Date:
i. Time in (doors open to public):
ii. Time out (doors locked):
PLEASE COMPLETE THE FOLLOWING. (Caretaker will prepare the facility per information supplied).
1) Estimated number of people attending the function:
2) Select what is required:
3) Date and time(s) prior to the function: (i.e. decorating, table and chairs setup, bar supplies, caterers, photographer) Date: In: Out: Purpose: Date: In: Out: _ Purpose: Date: In: Out: _ Purpose:
4) Date and time(s) of the function:
Day 1: Time In (Doors Open): Time Out (Doors Closed): Day 2: Time In (Doors Open): Time Out (Doors Closed): Day 3: Time In (Doors Open): Time Out (Doors Closed): *DAMAGE DEPOSIT $200.00 *KEY DEPOSIT $100.00 *SOUND SYSTEM & PROJECTOR DEPOSIT --- --------------------------------------- $150.00
