Alternate Phone. Email Address: Owner Date of Birth: Owner Driver’s Lic.#/State: Tax ID#: Contractor Name: Contractor Address: This agreement is subject to the Terms and Conditions on the back of this agreement. The Narragansett Electric Company d/b/a National Grid (National Grid) agrees to install a gas service to the above location (Premises). I understand that I may cancel this agreement, without obligation, at anytime prior to the installation of the gas service line. I hereby authorize National Grid to install a natural gas service line to the address noted above. PAYMENT INFORMATION: Please do not send payment along with this contract. An invoice will be generated upon receipt of this application with the option to pay by check. Please note: all invoices must be paid within thirty days. Residence Type Gas Equipment (Please indicate below if Single family equipment is Existing = E or New = N) Multi family # Units Individual meters Heating ( Std HE ) Generator Heat Water Htg. Grill Non-heat Cooking Light House meter Drying Pool Htr. Single meters Fireplace Garage Htr. Planned Equipment installation date / / Site Information Surrounding Area: Wetlands/water Historic Nature Preserve Undeveloped Urban Corner Lot Public Road Private Roadway State Road (Please mark for meter location and indicate street and cross street names) 1 9 Cross Street Cross Street 2 8 3 7 4 5 6 Street Name House square footage: Mtr. location #: Distance of house to street: Distance from front ( right left ) corner of house: Mtr. location: Outside Marked Connection from (Street Name): Parking restrictions: Conditions on private property along proposed service route (check all that apply): Wall Flower Beds Walkway Driveway Sprinkler Cesspool/Septic Trees Ledge/Rock Underground electric/phone/cable Underground Oil Tank Waterline None of the above Target Date: All shaded areas are Target/Comp ID: for company use Work Order #: Easement Permits: Town State Conservation Private Road Describe work requested: Unit BTU/HR Heating BTU Rate Mtr. Size Mtr. 1 Mtr. 2 Mtr. 3 Mtr. 4 Mtr. 5
Alternate Phone. Fax Number:
Alternate Phone. Email Address: Boat Name: Make: Model & Year: Delaware Registration Certificate Number: Security Deposit: $ , due from Lessee on the date above, at the time of signing the Agreement. Beginning date: End date (subject to Section 2): This Boat Slip Lease Agreement (this “Agreement”) is made on the date set forth above by and between the Town of Xxxxxx, a municipal corporation of the State of Delaware, with its office at 000 Xxxxxxx Xxxxxx, Xxxxxx, Xxxxxxxx 00000 (“Lessor”), and Lessee.
Examples of Alternate Phone in a sentence
No. TRS Membership/Retirement NumberCity State Zip Code Primary Phone Number (Check one:( )Email Address Alternate Phone Number (Check one:( )Home HomeWork WorkMobile) Mobile) Check here if you entered new contact information above.
Contact: Phone: ---------------------- ---------- ---------------------- ---------- Alternate: Phone: Alternate: Phone: --------------- -------------------- --------------- -------------------- ACCESS PROVIDER: ACCESS PROVIDER: ---------------- ---------------- QCC REQUIRES 5 WORKING DAYS FROM RECEIPT OF QCC REQUIRES 5 WORKING DAYS FROM RECEIPT OF DLR TO COMPLETE CIRCUIT INSTALLATION.
For additional information regarding private security company licensing, contact the Arizona Department of Public Safety at (602)223-2361.SecurityName of responsible person to be present for duration of event: Home Address: Business Address: Home Phone Number: Alternate Phone Number: Type of Private Security Personnel/ Company Name: I plan to use:In-house staff or volunteers.
City Zip Code _ Home Phone ( ) Parent Cell Phone ( ) Alternate Phone ( ) E-mail Applying to: Grade 9 Grade 10Academies:Students may apply to one or more academy.
Relationship to child: Cell or Alternate Phone #: ( ) Natural Disaster Contact: In the event of fire, earthquake or other serious emergency, the school may implement a controlled release of students for their safety and well being.
More Definitions of Alternate Phone
Alternate Phone. Email Address: Owner Date of Birth: Owner Driver’s Lic. #/State: Tax ID#: Contractor Name: Contractor Address: This agreement is subject to the Terms and Conditions on the back of this agreement. The Narragansett Electric Company d/b/a National Grid (National Grid) agrees to install a gas service to the above location (Premises). I understand that I may cancel this agreement, without obligation, at anytime prior to the installation of the gas service line. I hereby authorize National Grid to install a natural gas service line to the address noted above. Unit BTU/HR ADTH Rate Mtr. Size Xxx. 0 Xxx. 0 Xxx. 0 Xxx. 0 Xxx. 0 Xxx. 0
Alternate Phone. Email: Community you wish to lead:
Alternate Phone. Email Address: Owner Date of Birth: Owner Driver’s Lic. #/State: Tax ID#: Contractor Name: Contractor Address: This agreement is subject to the Terms and Conditions on the back of this agreement. KeySpan Gas East Corporation, d/b/a National Grid, NY (National Grid) agrees to install gas service to the above location (Premises). I understand that I may cancel this agreement, without obligation, at any time prior to the installation of the gas service line and main. I hereby authorize National Grid to install a natural gas service line to the address noted above. Unit BTU/HR Heating BTU Rate Mtr. Size Xxx. 0 Xxx. 0 Xxx. 0 Xxx. 0 Xxx. 0
Alternate Phone. Email Address: Phone: Alternate Phone: Coordinator is committed to picking up trash and litter along the section of Highway , from milepost to and expects to have approximately participants attend the volunteer trash pick-event, which is scheduled on the following date (and times): . Coordinator (collectively including Coordinator’s Authorized Agent) has read and understands all provisions contained below and attached, and will abide by them and any other enumerated terms and conditions as required by the New Mexico Department of Transportation (NMDOT) for participation in the subject volunteer track pick-up activity for which Coordinator seeks permit. Coordinator is also responsible for ensuring such compliance by each of its group participants (Participants) during the scheduled clean-up event.
Alternate Phone. Email Address: Owner Date of Birth: Owner Driver’s Lic.#/State: Tax ID#: Contractor Name: Contractor Address: This agreement is subject to the Terms and Conditions on the back of this agreement. The Narragansett Electric Company d/b/a National Grid (National Grid) agrees to install a gas service to the above location (Premises). I understand that I may cancel this agreement, without obligation, at anytime prior to the installation of the gas service line. I hereby authorize National Grid to install a natural gas service line to the address noted above. PAYMENT INFORMATION: Please do not send payment along with this contract. An invoice will be generated upon receipt of this application with the option to pay by check. Please note: all invoices must be paid within thirty days. Owner/Applicant Signature: Date: Unit BTU/HR Heating BTU Rate Mtr. Size Mtr. 1 Mtr. 2 Mtr. 3 Mtr. 4 Mtr. 5
Alternate Phone. Email Address: Owner Date of Birth: Owner Driver’s Lic.#/State: Tax ID#: Contractor/Lic. Plumber Name: Contractor/Lic. Plumber Address: This agreement is subject to the Terms and Conditions on the back of this agreement. Brooklyn Union Gas Company d/b/a National Grid, NY (National Grid) agrees to install gas service to the above location (Premises). I understand that I may cancel this agreement, without obligation, at any time prior to the installation of the gas service line and main. I hereby authorize National Grid to install a natural gas service line to the address noted above. Unit BTU/HR Heating BTU Rate Mtr. Size Xxx. 0 Xxx. 0 Xxx. 0 Xxx. 0 Xxx. 0
Alternate Phone. Email: Age: DOB: Gender: Marital Status: Referred by: Organization: City: State: Zip: