Your Authorization. By accepting coverage under this Contract, You permit the Company to request any information related to a claim for services that You received and authorize that any information may be given to the Company regarding medical services You have received. This applies to all types of claims, including claims related to Medicare.
Your Authorization. You represent that You have full right and/or authorization to enter into this Agreement.
Your Authorization. You authorize us to hold, receive, and disburse funds on your behalf. Your authorization permits us to generate a paper draft or an electronic funds transfer to process each payment transaction that you authorize. The authorizations will remain in full force and effect until your StrongBox Account is closed and/or terminated.
Your Authorization. In addition to our use of your health information for treatment, payment, or healthcare operations, you may give us
Your Authorization. By signing below, I authorize Mutual of Omaha to obtain and use consumer reports about me in order to evaluate my eligibility to contract with Mutual of Omaha as an insurance producer. If I do contract with Mutual of Omaha as an insurance producer, by signing below, I also authorize Mutual of Omaha to obtain and use consumer reports about me while my contract is in effect in order to evaluate my continued eligibility to remain an insurance producer for Mutual of Omaha. Candidate Signature Date Print Name Consumer reports may include, among other things, information about your credit history, criminal record and history, and insurance department regulatory actions. We will obtain a copy of your consumer report from: Name/Address/Phone Yes, please provide me a copy of the consumer report This General Agent Agreement (“Agreement”) is entered into between the undersigned General Agent (“GA”) and Mutual of Omaha Insurance Company, and each affiliated insurance company as specified on the Compensation/Product Schedule(s) attached to the Agreement (hereinafter referred to as the “Company”). The parties agree that additional affiliates of the Company may be added to the Agreement at a later date by way of changes/additions to the Compensation/Product Schedules attached hereto. Any Company affiliate added to the Agreement will be thereafter included in the definition of “Company”.
Your Authorization. If you do not agree to the terms and conditions in this Agreement, you may not complete the registration process. Checking the box entitled, "I have reviewed and agree to the terms and conditions contained in the Consumer Internet Agreement." and proceeding to use the Online Services services indicates your acknowledgement that you have read and accepted these terms and conditions. By making payments on your LoanMe loan account through Online Services, you are authorizing LoanMe to electronically charge your checking or savings account for the amount you submitted. If you want to use this method of payment, you must complete this authorization process each time. You will receive an email notification each month stating that your loan statement is available for online viewing and payment. You are not required by LoanMe to authorize LoanMe to make electronic charges to your checking or savings account as your method of payment. You may continue to make payments on your loan account through any other method acceptable to LoanMe. If you wish to revoke your consent to monthly electronic loan statements, please contact customer service.
Your Authorization. If you do not agree to the terms and conditions in this Agreement, you may not complete the registration process. Checking the box entitled, "I have reviewed and agree to the terms and conditions contained in the Consumer Internet Agreement." and proceeding to use the Online Services services indicates your acknowledgement that you have read and accepted these terms and conditions. By making payments on your AmeriFirst Home Improvement Finance loan account through Online Services, you are authorizing AmeriFirst Home Improvement Finance to electronically charge your checking or savings account for the amount you submitted. If you want to use this method of payment, you must complete this authorization process each time. You will receive an email notification each month stating that your loan statement is available for online viewing and payment. You are not required by AmeriFirst Home Improvement Finance to authorize AmeriFirst Home Improvement Finance to make electronic charges to your checking or savings account as your method of payment. You may continue to make payments on your loan account through any other method acceptable to AmeriFirst Home Improvement Finance. If you wish to revoke your consent to monthly electronic loan statements, please contact customer service.
Your Authorization. Subject to this Agreement, you authorize us to hold, receive and disburse funds in accordance with your payment instructions, whether provided to us directly or through a Provider's Application, and whether to us in our own capacity or in our capacity as payment processor acting on behalf of sellers of goods or services and other third parties that have appointed us as agent for the limited purpose of receiving payments. Your authorization permits us (a) to debit or credit your Balance, a Bank Account, any credit card, debit card, or other payment cards that we accept (" Cards "), or any other payment method we accept, or (b) to process payment transactions that you authorize by generating a paper draft or an electronic funds transfer. Your authorizations will remain in full force and effect while you maintain your Payment Account with us and for any Bank Account.
Your Authorization. In addition to our use of your health information for treatment, payment or health care operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us a written authorization, you may revoke it in writing at any time, although such revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us written authorization, we will not use or intentionally disclose your health information for any reason except those described in this Notice.
Your Authorization. If you do not agree to the terms and conditions in this Agreement, you may not complete the registration process. Checking the box entitled, "I have reviewed and agree to the terms and conditions contained in the Consumer Internet Agreement” and proceeding to use the Online Services service indicates your acknowledgement that you have read and accepted these terms and conditions. By making payments on your First Metropolitan loan account through Online Services, you are authorizing First Metropolitan to electronically charge your checking account, savings account, or debit card for the amount you submitted. If you want to use this method of payment, you must complete this authorization process each time. You will receive an email notification each month stating that your loan statement is available for online viewing and payment. You are not required by First Metropolitan to authorize FMFS to make electronic charges to your checking account, savings account, or debit card(s). You may continue to make payments on your loan account through any other method of payment acceptable to First Metropolitan. If you agreed to terminate receipt of a monthly paper loan statement and accept presentation of a monthly electronic loan statement, you do not need to do anything further. If you wish to revoke your consent to monthly electronic loan statements; log on to Online Services, select the E-statement menu item and Set your Statement Preferences. Then change your delivery preference from Electronic to Paper.
