Subscriber Name. Last: First: Date of Birth: Drivers License/ID: State: Spouse name (or others who have authorization to make changes to this account): Last: First: Physical Address: Street: City: State: Zip: Mailing Address: Street: City: State: Zip: Home Phone: Cell Phone: Work Phone: Email Address: Would you like to receive your billing statements by email? □ Yes | □ No
Subscriber Name. Xxxx to the attention of: Address: Phone Number: Fax Number: Vendor providing service: For purpose of qualifying for OPRA's reduced member subscriber fee, Subscriber certifies that It is a member or associate member In good standing of the following Participant Exchanges (check all that apply): / / American Stock Exchange / / Chicago Board Options Exchange / / New York Stock Exchange / / Pack Stock Exchange / / Philadelphia Stock Exchange FOR OPRA USE ONLY APPROVED: Subscriber No. OPTIONS PRICE REPORTING AUTHORITY Location No. 000 XXXXX XXXXXXX XXXXXX Start Date XXXXXXX, XXXXXXXX 00000 Number of Devices USA (000)-000-0000 By Date of Approval Subscriber remains responsible for all fees due to OPRA hereunder, even if a third party has agreed to pay such fees on behalf of Subscriber * Whenever an asterisk follows the first use of a term, Paragraph I defines the term. AGREEMENT FOR RECEIPT OF CONSOLIDATED NETWORK A DATA AND NYSE MARKET DATA This Agreement permits the undersigned "Subscriber to arrange with authorized vendors or with the New York Stock Exchange, Ink. ("NYSE"), as appropriate to receive any one or more Types of Market Data* and to use that Market Data for interrogation* display, tape* display or other purposes not entailing retransmission. This Agreement governs whichever Type(s) of Market Data, means of receipt and use(s) Subscriber receives, arranges and makes. Subscriber and NYSE agree to all terms and conditions of this Agreement. Subscriber Name: Xxxxxx Xxxx & Xxxxxxxx 0000 Xxx Xxxxxx, Ste. 301 Houston, TX 77056 USA Name and Title of Individual Signing: Xxxxx X . Xxxx Billing address if different than above: same as above Taxpayer ID or Social Security No. ###-##-#### Type of Business: Investment Banking Tel. No. 000-000-0000 CHECK BOX IF MEMBER OF: American Stock Exchange, Inc. / / Cincinnati Stock Exchange, Inc. / / New York Stock Exchange, Inc. / / Boston Stock Exchange, Inc. / / Midwest Stock Exchange, Inc. / / Pacific Stock Exchange, Inc. / / Chicago Board Options Exchange, Inc. / / National Association of / / Philadelphia Stock Exchange, Inc. / / Securities Dealers, Inv. SUBSCRIBER , NEW YORK STOCK EXCHANGE, INC. On behalf of the CTA Plan Participants (in respect of CTA Network A last sale information) and the CQ Plan Participants (in respect of CQ Network A quotation information) and on its own behalf solely (in respect of NYSE Securities Information*) By: Xxxxx X. Xxxx By: Dated: Dated:
Subscriber Name the entity that has entered into the Subscriber Agreement (as defined in Schedule 5). Location Address: the full postal address for the location of the entity that receives Information.
Examples of Subscriber Name in a sentence
Signature of Subscriber: Signature of Joint Subscriber, if applicable: By: By: Name: Name: Title: Title: Date: Name of Subscriber: Name of Joint Subscriber, if applicable: (Please print.
SUBSCRIBER** Date: _____________ Signature of Subscriber Name of Subscriber [Please Print] Address of Subscriber SSN or Tax ID of Subscriber CO-SUBSCRIBER** Date: _____________ Signature of Co-Subscriber Name of Co-Subscriber [Please Print] Address of Co-Subscriber State of incorporation/corporate domicile (if different than the address listed above): _________________________.
Client Signature Date Counselor Signature Date INSURANCE INFORMATION FORM Primary Coverage: Insurance Company Name Patient Name: Subscriber Name: Subscriber: Sex: M F Birthdate: SSN: Patient/Subscriber Relationship: Employer: Effective Date: Group #: Insurance ID#: Insurance Phone#: Authorization to Release Information: I hereby authorize Dana R.
Signature of Subscriber: Signature of Joint Subscriber, if applicable: By: By: Name: Name: Title: Title: Name of Subscriber: Name of Joint Subscriber, if applicable: (Please print.
Subscriber Name (First, Last)Date of Birth (MM/DD/YYYY)Social Security / I.D. #Street Address / P.O. Box No.Apt.
More Definitions of Subscriber Name
Subscriber Name. Last: First: Date of Birth: Spouse name (or others who have authorization to make changes to this account): Last: First: Street: City: State: Zip: Mailing Address: City: State: Zip: Home Phone: Cell Phone: Work Phone: Other: Email Address: Would you like to receive your billing statements by email? □ Yes | □ No Router: □ Yes | □ No Managed: □ Yes | No □ Basic Web Browsing (Up to 2Mb/s) $54.99 $29.99 $84.98 □ □ Basic Video Streaming & Gaming (Up to 6Mb/s) $54.99 $39.99 $94.98 □ □ Advanced Video Streaming & Gaming (Up to 8Mb/s) $54.99 $49.99 $104.98 □ □ Basic Multi-User (Up to 12Mb/s) $54.99 $59.99 $114.98 □ □ Advanced Multi-User (Up to 15Mb/s) $54.99 $69.99 $124.98 □
Subscriber Name. Email: Date: Issuer: By: /s/ Mxxx X. Xxxxxxx Name: Mxxx X. Xxxxxxx Company: Level Brands, Inc. Title: Chief Financial Officer and Chief Operating Officer
Subscriber Name. Address:___________________________ __________________________________ __________________________________
Subscriber Name. Address: __________________________________ ___________________________________________ ___________________________________________ SS or Tax ID No.: _________________________ Number of shares purchased _____________________ Price per share _____________________ Total purchase price $____________________ The total purchase price shall be paid on or before ____________, 2003.
Subscriber Name. Service Address: City: State: Zip Code: Account:
Subscriber Name. Email: Date: Signature ID: _____________________ Legal Name of Entity By _____________________ Subscriber: _____________________ Name: Email: Date: Signature ID: _____________________ Name: Title:
Subscriber Name. ADDRESS: PHONE: FAX: NETGATEWAY 000 Xxxxxxxxx, Xxxxx 000 Xxxx Xxxxx, XX 00000 Phone: (000) 000-0000 Fax: (000) 000-0000