ContractElectronic Signature Agreement • February 15th, 2022
By typing your name on the signature lines of this document and sending it to us electronically, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manually/handwritten signature on this Agreement. By typing your name on the signature line, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred as your “E- Signature”) is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and The Clinical Skin Center of Northern Virginia, PLLC. You are also confirming that you are the person or their authorized representative entering into this Agreement.
ContractElectronic Signature Agreement • February 28th, 2018
ContractElectronic Signature Agreement • February 28th, 2018
Appendix B. HRSD Electronic Signature AgreementElectronic Signature Agreement • November 15th, 2021
Use this Electronic Signature Agreement (ESA) to request Responsible Official (RO) privileges, which allow the user to electronically submit permitting and monitoring data to HRSD.
ContractElectronic Signature Agreement • July 6th, 2016
Electronic Signature AgreementElectronic Signature Agreement • December 10th, 2008
$ I agree to maintain the security of the UserID and Password assigned to me by U.S. EPA for use of the CAMD Business System, in order to prevent disclosure of this information to anyone.
Santa Barbara County Department of Behavioral Wellness Electronic Signature AgreementElectronic Signature Agreement • January 17th, 2019
Electronic Signature AgreementElectronic Signature Agreement • December 10th, 2008
$ I agree to maintain the security of the UserID and Password assigned to me by U.S. EPA for use of the CAMD Business System, in order to prevent disclosure of this information to anyone.
Submit Initial Electronic Signature Agreement forms to: Mental Health Plan: BWellQCM@sbcbwell.orgElectronic Signature Agreement • October 8th, 2020
ELECTRONIC SIGNATURE AGREEMENTElectronic Signature Agreement • August 3rd, 2022
This Agreement governs the rights, duties, and responsibilities of San Bernardino County Department of Behavioral Health (DBH) in the use of an electronic signature in San Bernardino County. The undersigned understands that this Agreement describes the obligations to protect his/her electronic signature, and to notify appropriate authorities if it is stolen, lost, compromised, unaccounted for, or destroyed. I agree to the following terms and conditions:
Electronic Signature Agreement (ESA) for EPA’s Verify System To be signed and submitted by a Company Approving OfficialElectronic Signature Agreement • December 10th, 2020
Agree to protect the electronic signature credential, consisting of my Central Data Exchange (CDX) user identification and password, from use by anyone except me. Specifically, I agree to maintain the secrecy of the password; I will not divulge or delegate my user name and password to any other individual; I will not store my password in an unprotected location; and I will not allow my password to be written into computer scripts to achieve automated login.
ELECTRONIC SIGNATURE AGREEMENTElectronic Signature Agreement • November 26th, 2019
This Agreement governs the rights, duties, and responsibilities of San Bernardino County Department of Behavioral Health (DBH) in the use of an electronic signature in San Bernardino County. The undersigned understands that this Agreement describes the obligations to protect his/her electronic signature, and to notify appropriate authorities if it is stolen, lost, compromised, unaccounted for, or destroyed. I agree to the following terms and conditions:
ELECTRONIC SIGNATURE AGREEMENTElectronic Signature Agreement • August 23rd, 2020
The undersigned Individual and Employing Entity attest that they have entered into an agreement effective on the date indicated below. Both parties agree an authorized representative of the Employing Entity has the authority to sign and submit the electronic Michigan Department of Health and Human Services Medical Assistance Provider Enrollment Trading Partner Agreement and to maintain enrollment information through the MDHHS CHAMPS Provider Enrollment Subsystem. Both parties also agree that the Employing Entity listed above is liable and bound by all information submitted on his or her behalf as if the Employing Entity had submitted changes to CHAMPS directly.
Electronic Signature AgreementElectronic Signature Agreement • February 28th, 2024
The electronic signature(s) generated through this process hold legal validity, equivalent to the use of a pen on paper communications. By utilizing your electronic signature, you confirm that it is enforceable to the same extent as a hand-written signature, serving as an original for the enforcement of communications containing the electronic signature(s) in court (state or federal), arbitration, or any other legal proceedings. You commit not to raise defenses or invoke regulatory or statutory claims that seek to invalidate the enforceability of communications bearing the electronic signature.
Electronic Signature AgreementElectronic Signature Agreement • August 25th, 2022
High Plains Regional Education Cooperative permits related service providers (i.e., therapists) to electronically authenticate service entries in TIENET/Service Capture.
ELECTRONIC SIGNATURE AGREEMENTElectronic Signature Agreement • August 4th, 2014
The undersigned understands that this Agreement describes my obligations to protect my electronic signature, and to notify appropriate authorities if it is stolen, lost, compromised, unaccounted for, or destroyed. I agree to the following terms and conditions:
Health Care Agency Behavioral Health Services ELECTRONIC SIGNATURE AGREEMENTElectronic Signature Agreement • February 5th, 2016
This Agreement governs the rights, duties, and responsibilities of County of Orange Health Care Agency (HCA) Behavioral Health Services (BHS) Staff and/or Contractor Staff in the use of an electronic signature in the County of Orange, California. The undersigned (I) understands that this Agreement describes my obligations to protect my electronic signature, and to notify appropriate authorities if it is stolen, lost, compromised, unaccounted for, or destroyed. For purposes of this Agreement electronic signature constitutes my Integrated Records Information System (IRIS) User Name and Password.
ContractElectronic Signature Agreement • May 8th, 2018
In accepting the electronic signature credential issued by the U.S. Environmental Protection Agency (EPA) to sign electronic documents submitted to EPA's Central Data Exchange (CDX), and as a representative for:
ELECTRONIC SIGNATURE AGREEMENTElectronic Signature Agreement • July 30th, 2012
This notice describes our Electronic Signature Agreement, how your Electronic Signature may be obtained and used, and your rights in regard to this information. Please review it carefully. If you have any questions about this notice, please contact our office at (919) 563-0000, info@matteochiropractic.com, or Matteo Chiropractic, PLLC, 941 S Fifth Street, Mebane, NC 27302.
ELECTRONIC SIGNATURE AGREEMENTElectronic Signature Agreement • November 19th, 2019
This Agreement governs the rights, duties, and responsibilities of Department of Mental Health in the use of an electronic signature in County of Los Angeles. In addition, I, the undersigned, understand that this Agreement describes my obligations to protect my electronic signature, and to notify appropriate authorities if it is stolen, lost, compromised, unaccounted for, or destroyed.
ContractElectronic Signature Agreement • January 18th, 2018
ContractElectronic Signature Agreement • October 4th, 2021
This Agreement, as amended from time to time (eSignature Agreement), governs your use of the CIBC World Markets Inc. (CIBC Wood Gundy) electronic signature system provided by us to access or use our services electronically (electronic signature system). By signing below, you agree to the terms of this eSignature Agreement.
Electronic Signature AgreementElectronic Signature Agreement • April 24th, 2019
In accepting the electronic signature credential issued by the United States Environmental Protection Agency (EPA) to sign electronic RMP forms submitted to EPA's Central Data Exchange (CDX), on behalf of:
ELECTRONIC SIGNATURE AGREEMENT for Michigan Air Emissions Reporting System (MAERS)Electronic Signature Agreement • September 21st, 2020
In order to become the Primary Preparer and receive a Personal Identification Number (PIN) for submittal of your emission inventory report, you must print this form, sign it, and return it to the Michigan Department of Environment, Great Lakes, and Energy (EGLE). Once the form is received, EGLE personnel will review your application and approve your Primary Preparer account as appropriate.
Erwin Utilities’ Electronic Signature AgreementElectronic Signature Agreement • July 13th, 2021
By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By selecting "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third-party verification is necessary to validate your E-Signature and that the lack of such certification or third-party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and Erwin Utilities. You also represent that you are authorized to enter into this Agreement for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of
Electronic Signature AgreementElectronic Signature Agreement • January 30th, 2017
The undersigned Individual and Employing Entity attest that they have entered into an agreement effective on the date indicated below. Both parties agree an authorized representative of the Employing Entity has the authority to sign and submit the electronic Illinois Department of Healthcare and Family Services Medical Assistance Provider Enrollment Trading Partner Agreement and to maintain enrollment information through the H FS IMPACT Provider Enrollment Subsystem. Email completed form to Impact.Help@Illinois.Gov
Electronic Signature AgreementElectronic Signature Agreement • January 30th, 2017
The undersigned Individual and Employing Entity attest that they have entered into an agreement effective on the date indicated below. Both parties agree an authorized representative of the Employing Entity has the authority to sign and submit the electronic Illinois Department of Healthcare and Family Services Medical Assistance Provider Enrollment Trading Partner Agreement and to maintain enrollment information through the H FS IMPACT Provider Enrollment Subsystem.
Electronic Signature AgreementElectronic Signature Agreement • September 14th, 2020
• I agree to maintain the security of the User ID and Password assigned to me by U.S. EPA for use of the CAMD Business System, in order to prevent disclosure of this information to anyone.
AGREEMENT TO TERMSElectronic Signature Agreement • March 23rd, 2021
By clicking Sign & Send below you agree to the terms contained herein, and that terms are binding in your jurisdiction as defined in our Electronic Signature Disclosure & Consent
Electronic Signature AgreementElectronic Signature Agreement • May 26th, 2020
This Agreement will allow you to electronically submit forms and reports using the DEQ ePortal and SLEIS systems when those forms and reports require a signature, using the account identified by your email address. To receive the necessary authorization, you must fill out this form completely, sign it, and send the original to:
ContractElectronic Signature Agreement • December 14th, 2017
This document is for example purposes only. DO NOT print and sign this form. Contact DNRSwitchboard@Wisconsin.gov if you have questions.
AGREEMENT TO TERMSElectronic Signature Agreement • March 23rd, 2021
By clicking Sign & Send below you agree to the terms contained herein, and that terms are binding in your jurisdiction as defined in our Electronic Signature Disclosure & Consent
AGREEMENT TO TERMSElectronic Signature Agreement • March 23rd, 2021
By clicking Sign & Send below you agree to the terms contained herein, and that terms are binding in your jurisdiction as defined in our Electronic Signature Disclosure & Consent
MARIN WITS ELECTRONIC SIGNATURE AGREEMENTElectronic Signature Agreement • July 8th, 2015
This Agreement governs the rights, duties, and responsibilities of County of Marin- Health & Human Services staff and contract providers in the use of an electronic signature in Marin WITS. A Marin Wits is comprised of user’s unique user name, password and pin. The undersigned (I) understands that this Agreement describes my obligations to protect my electronic signature, and to notify appropriate authorities if it is stolen, lost, compromised, unaccounted for, or destroyed. I agree to the following terms and conditions:
Electronic Signature AgreementElectronic Signature Agreement • October 19th, 2017
As a convenience, Lakeway Christian Schools (LCS) will utilize electronic forms to obtain important information from our families. Under this method, parents and/or legal guardians will have the option to sign certain documents electronically. The documents executed electronically will be treated like a physical handwritten signature on a paper form. The law requires that we provide certain information to you and obtain your consent to use an electronic signa- ture. Please carefully read the following information.
