Please Print. OR TYPEWRITE NAME AND ADDRESS, INCLUDING POSTAL ZIP CODE OF ASSIGNEE the within Series G Senior Note and all rights thereunder, hereby irrevocably constituting and appointing _______________________________________________________________________________.
Please Print. OR TYPEWRITE NAME AND ADDRESS, INCLUDING POSTAL ZIP CODE OF ASSIGNEE the within Debenture and all rights thereunder, hereby irrevocably constituting and appointing _______________________________________________________________________________.
Please Print. Renter: Mailing Address: Daytime Phone: Date of Birth: Drivers License Number Date of Shelter Use: Time of Shelter Use: Will alcohol be present & consumed during the event? YES NO Veterans Park Shelter – Kitchen, Indoor & Outdoor Seating Rental Fee Tax Damage Deposit TOTAL $125.00 $8.91 $50.00 $183.91 Are All Due At The Time Of Reservation. Banquet Hall Seating Capacity – 86 Outdoor Seating Capacity – 48 The Renter must sign this Rental Agreement in the space provided below. By doing so, the Renter agrees to adhere to the following requirements; unless special arrangements have been noted by City Staff on this Rental Agreement and agrees to accept the consequences for their failure to do so. I hereby acknowledge that I have received a Clean-Up Check List and a copy of the Ordinance related to the consumption of alcohol at Veterans Park. Renter’s Signature Date City Approval Date Facilities Available At Veterans Park ⮚ Oven & Stove ⮚ Microwave ⮚ Refrigerator ⮚ Double Sink ⮚ Counters ⮚ Electrical Outlets ⮚ Restrooms ⮚ Playground Equipment ⮚ Charcoal Grills ⮚ 6 – Picnic Tables ⮚ 2 – Volleyball Courts & Nets ⮚ Folding Tables (Blue – Office Copy, White – Customer Copy) ⮚ Folding Chairs ⮚ Boat Access To Lake Koronis ⮚ Walking/Biking Trail System ⮚ Swimming Beach With Lifeguards Please see back for park regulations.
Examples of Please Print in a sentence
PLEASE PRINT OR TYPE THE FOLLOWING INFORMATION: LPHA Name (exactly as filed with the IRS): Street address: City, state, zip code: Email address: Telephone: ( ) Facsimile: ( ) Federal Employer Identification Number: Proof of Insurance: Workers’ Compensation Insurance Company: Policy #: Expiration Date: The above information must be provided prior to Agreement approval.
INDIVIDUAL/COMPANY INFORMATION INDIVIDUAL/ORGANIZATION NAME: (PLEASE PRINT) 1.
Student Name (PLEASE PRINT) Student Signature Grade Date By signing below, I understand my daughter/son will be using the above online educational technology tools.
SAMPLE CLIENT APPLICATION {CONTRACTOR LETTERHEAD} SAMPLE Application for Senior Non-Emergency Medical Transportation Program PLEASE PRINT CLEARLY.
Please Print or Type ADDRESS UNIT #’S CITY 🞎 Home 🞎 Condo 🞎 Complex Mailing Address for your Accounts Payable office: (PLEASE PRINT OR TYPE) By signing this Agreement, you acknowledge that you have read and understand the Owner Allocation Agreement and your safety responsibility when requesting electric service with Southern California Edison.
More Definitions of Please Print
Please Print. OR TYPEWRITE NAME AND ADDRESS OF TRANSFEREE) [●] nominal amount of the Instruments represented by this Certificate, and all rights under them. Dated ........................................................ Signed .............................................
Please Print. Date: Circle a Facility: Sgt. Xxxxxx Xxxx (Banquet Hall) Sgt. Jasper Park (Gazebo) Sgt. Jasper Park (Picnic Shelter) Person Responsible: Phone: Mailing Address: City: State: Zip Code: Additional Contact Person Phone:
Please Print. Date: Name: Street Address: City, State, & Zip: Phone Number: Email: For good and valuable consideration, the exchange, receipt, and sufficiency of which the parties hereto hereby acknowledge, Pace University agrees to grant the above-named person (“You”) access to Pace University School of Law Library in accordance with the following terms and conditions (“Bar Review Access Contract”): General: Bar Review Access may be purchased by individuals who are not graduates of Pace University, and who are studying to take the February or July administration of the bar exam. Seekers of Bar Review Access must show proof acceptable to Pace University in its sole and confidential discretion that such seekers are studying for the February or July Bar Exam at the time of purchase. Acceptable forms of proof are: bar exam registration receipt, or the receipt or ID issued by a commercial bar preparation course. The access granted by this Bar Review Access Contract is granted to you alone and is accordingly nontransferable. You may not assign or otherwise transfer this Bar Review Access Contract or its rights or responsibilities to any other person or entity. You hereby acknowledge that your failure to comply with any Law Library or University rules, regulations, or procedures or with directives of authorized University personnel may subject the noncompliant individual to immediate ejection from University property and termination of this Bar Review Access Contract, without refund. You must reshelve any and all materials you use. A complete set of Law Library rules is available at xxxx://xxx.xxxx.xxx.
Please Print. OR TYPEWRITE NAME AND ADDRESS, INCLUDING POSTAL ZIP CODE OF ASSIGNEE the within Series A Senior Note and all rights thereunder, hereby irrevocably constituting and appointing . . . . . . agent to transfer said Series A Senior Note on the books of the Company, with full power of substitution in the premises. Dated: ,
Please Print. DATE SERVICE TO START: APPLICANT'S NAME: CO-APPLICANT'S NAME: _ MAILING ADDRESS: PHYSICAL ADDRESS: PHONE NUMBER Home ( ) - Work ( ) - Cell ( ) - Cellphone Carrier: EMAIL ADDRESS: PROOF OF OWNERSHIP/RENTAL AGREEMENT PROVIDED: YES NO NUMBER OF OCCUPANTS LANDLORD INFORMATION ACCT # ADDRESS PHONE ( ) - DRIVER'S LICENSE NUMBER OF APPLICANT State DATE OF BIRTH OF APPLICANT: DRIVER'S LICENSE NUMBER OF CO-APPLICANT State DATE OF BIRTH OF CO-APPLICANT: APPLICANTS EMPLOYED BY: PHONE ( ) - CO-APPLICANTS EMPLOYED BY: PHONE ( ) - _ PREVIOUS ADDRESS EMERGENCY CONTACT PHONE ( ) - SPECIAL SERVICE NEEDS OF APPLICANT By signing this application I agree to pay the balance billed each month by the City of Xxxxx and any balance owed upon ending my water service with the City of Xxxxx. I have received a copy of the “Rates & Regulations” and will abide by the rules and regulations and any revisions made in the future. Signature NOTE: FORM MUST BE COMPLETED BY APPLICANT ONLY. Date: The following information is requested by the Federal Government in order to monitor compliance with Federal laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname. PLEASE CHECK ALL THAT APPLY.
Please Print. CLEARLY or TYPE the names of the beneficiaries. • To name a trust as beneficiary, please provide the name of the trustee(s) and the exact name and date of the trust agreement. • To name your estate as beneficiary, please write “Estate of _[your name]_”. • Be aware that none of the contingent beneficiaries will receive anything unless ALL of the primary beneficiaries predecease you. • Except as otherwise defined in this instrument, the terms used in this instrument shall have the meaning set forth in the Plan. I understand that I may change these beneficiary designations by delivering a new written designation to the Plan Administrator, which shall be effective only upon receipt and acknowledgment by the Plan Administrator prior to my death. I further understand that the designations will be automatically revoked if the beneficiary predeceases me, or, if I have named my spouse as beneficiary and our marriage is subsequently dissolved. I hereby revoke any and all previous beneficiary designations made by me under the Plan. Name: Signature: Date: Received by the Plan Administrator this day of , 20 . By: Title: POLICY ENDORSEMENT Contract Owner: ENTERPRISE BANK AND TRUST COMPANY The undersigned Owner requests that the policy(ies) shown in the attached Schedule Page issued by the (the “Insurer”) provide for the following beneficiary designation:
Please Print. Clearly Or Type: Name of Applicant Name of Organization (Required) Mailing Address Phone Number E-Mail Address City/ State/Zip Code Signature of Authorized Applicant Date Date(s) Requested: Day(s) Of Week: (Please list) (Please list) Entrance Time to Facility: Exit Time From Facility: Start of Activity: End of Activity: I have read this Agreement and the Conditions of Use of Easton Public School property, and accept the responsibility for the sponsoring group for payment of bills, the observance of all regulations, and all terms hereof. I/we agree to a RENTAL FEE OF (plus services). A DEPOSIT of $ to be paid at the time the Facility Application is submitted unless other arrangements are agreed upon in advance. I understand that an Automated External Defibrillator (AED) may be available on school grounds and access to the device is conditioned on a conversation with the school principal regarding the location of the device, the rules of use, and my responsibility to provide a trained AED provider. Furthermore, I accept, on behalf of my organization, all liability concerning the use, misuse, or failure to use the AED. I understand EPS has no responsibility or liability concerning use, misuse, or failure to use the AED during the term of facilities usage described in this agreement.