PLEASE TYPE OR PRINT CLEARLY Clause Samples

PLEASE TYPE OR PRINT CLEARLY. THANK YOU.
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PLEASE TYPE OR PRINT CLEARLY.  Individual providers must enter their last name, first name and middle initial. All other applicants (e.g., a licensed business) must enter the complete business name as licensed/certified.  If the applicant is employed/contracted by a business, or in partnership, enter the name of the business you are employed by, affiliated with, contracted with, or in partnership with.  Proof of the EIN number (federal tax number) is REQUIRED.  Providers must attach a copy of their licensure/certification, as applicable.  The SSN is required for an individual and is confidential to be used only for the administration of the program.
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PLEASE TYPE OR PRINT CLEARLY. Item#1: Individual providers must enter their last name, first name, and middle initial. All other applicants (e.g., a licensed business) must enter the complete business name as licensed/certified. Item#2: If the applicant is employed/contracted by a business, or in partnership, enter the name of the business you are employed by, affiliated with, contracted with, or in partnership with. Item#4: Proof of the EIN number (federal tax number) and the NPI number (national provider identification – if applicable) is REQUIRED. Item#5: Providers must attach a copy of the licensure/certification, as applicable. Item#6: The SSN is required for an individual/OWNER and is confidential to be used only for the administration for the program.
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PLEASE TYPE OR PRINT CLEARLY. RESERVATION INFORMATION
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PLEASE TYPE OR PRINT CLEARLY. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
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Related to PLEASE TYPE OR PRINT CLEARLY

  • IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR ELECTRONIC TRANSFERS Call us at (866) ▇▇▇- ▇▇▇▇ or write us at Customer Care, ▇.▇. ▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ as soon as you can if you think your statement or receipt is wrong or if you need more information about an electronic transaction. We must hear from you no later than 60 days after we sent the FIRST statement on which the problem or error appeared. i. Tell us your name and account number. ii. Describe the error or the transfer you are unsure about, and explain as clearly as you can why you believe it is an error or why you need more information. iii. Tell us the dollar amount of the suspected error. In addition, it would be helpful if you provided us with any supporting documentation related to the error. If you tell us orally, we may require that you send us your complaint or question in writing within 10 business days. We will determine whether an error occurred within 10 business days after we hear from you and will correct any error promptly. If we need more time, however, we may take up to 45 days to investigate your complaint or question. If we decide to do this, we will credit your account within 10 business days for the amount you think is in error, so that you will have the use of the money during the time that it takes us to complete our investigation. If we ask you to put your complaint or question in writing and we do not receive it within 10 business days, we may not credit your account. For errors involving new accounts, point-of-sale, or foreign-initiated transactions, we may take up to 90 days to investigate your complaint or question. For new accounts, we may take up to 20 business days to credit your account for the amount you think is in error. We will tell you the results within three business days after completing our investigation. If we decide that there was no error, we will send you a written explanation. You may ask for copies of the documents that we used in our investigation.

  • YOUR BILLING RIGHTS - KEEP THIS NOTICE FOR FUTURE USE This notice tells you about your rights and our responsibilities under the Fair Credit Billing Act.

  • Country Specific Terms Appendix A contains additional terms and conditions of the Agreement applicable to Participants residing in those countries. In addition, Appendix A also contains information and notices of exchange control and certain other issues of which the Participant should be aware.

  • Product Specific Terms these terms apply to specific Products referenced in this section.