3776 S.R. 93 N.E., Crooksville, OH Toll Free (866) * Phone (740) * Fax (740)

Size: px
Start display at page:

Download "3776 S.R. 93 N.E., Crooksville, OH Toll Free (866) * Phone (740) * Fax (740)"

Transcription

1 3776 S.R. 93 N.E., Crooksville, OH Toll Free (866) * Phone (740) * Fax (740)

2 Name of Dealer: Telephone ( ) (Legal Name if Different) Fax# ( ) (Hereinafter Referred to as Dealer) Address: City ST. Zip BUSINESS INFORMATION Is the Dealer: An Individual Partnership Corporation LLC Federal Tax ID# If Registered with AuctionAccess, please provide Dealership # Individual # When was Dealer Organized? / / Dealer License # Sales Tax # Do you expect to Buy Sell If you expect to buy, will you use: Cash Checks Drafts (Subject to Auction Approval) Type of Dealer: Franchised Used Wholesale Retail If Franchised, Make of Car Sold: *Auction and its insurers are authorized to investigate the history of Dealer and any of Dealer's Owner and Officers through banks, financial institutions, credit reporting agencies and other sources. YES NO List of Owners and Officers Name Title SSN Home Address Phone U.S. Citizen? Yes No Name Title SSN Home Address Phone U.S. Citizen? Yes No Name Title SSN Home Address Phone U.S. Citizen? Yes No CREDIT INFORMATION Bank Address Name of Official Account # Credit or Float Plan Limit How Long Doing Business? Finance Company Finance Company Address Name of Official Credit or Floor Plan Limit $ How Long Doing Business? *If you have done business with either of the above for less than 3 years, give previous financial institution(s) name and address. Bank Finance Company Address Address The information above is accurate. Dealer agrees to Auction's Rules & Regulations. /s/ Date Title

3 Dealer Name: Owner: Telephone: ( ) Address: Fax#: ( ) Dealer License#: Expiration Date: / / Federal ID#: Resale Tax#: BUSINESS TYPE Corporation Sole Proprietorship LLC Partnership AuctionAccess#: TYPE: Bank Franchise Government Independent Fleet/Lease Rental Salvage Wholesale Factory Bank Name: Contact: Branch Name: Address: City: State: Zip: Phone Number: ( ) Account Number:

4 Authorized Buyer Form (pg. l of 2) Please check one choice below: ADD CHANGE REMOVE :Authorized Buyer Dealer Name: Address: City ST Zip Phone Number: ( ) Authorized Buyer Name (Please Print): Authorized Buyer's Phone Number: ******** I,, represent I am the named account holder and authorize Value Auto Auction to add/remove/change the above person as an authorized buyer on this account as indicated above, subject to the terms on page 2 of this form.********* Printed Account Holder's Name: Date: Signature of Account Holder: Date: *By designating an authorized user on this account(s), you are granting permission for this person to access and/or make changes to your account(s). **By removing the authorized buyer on the account(s), you are revoking permission for this person to access and/or make changes to your Value Auto Auction account(s). ***You may be contacted should we have any questions regarding this form

5 References: Other Auctions You Attend: Other Auctions You Attend: Dealer or Other Business Reference: Authorized Representatives: Authorized Buyer Form (pg. 2 of 2) How Long Registered? How Long Registered? Telephone: The following person(s) are duly authorized to buy and sell automobiles, to execute checks or drafts, to execute bills of sales, assignments of titles and warranties of titles on behalf of Dealer. The authority of the following person(s) to act on behalf of the Dealer shall continue in full force and effect until terminated by Dealer in writing to the Auction. Dealer does hereby guarantee all transactions made by such person(s). Representative: Signature: SS#: DOB: / / Phone # Authorized to sell cars? YES NO Authorized to sign checks? YES NO Account Holder's Signature: Authorized to sign drafts? YES NO Date: / / Representative: Signature: SS#: DOB: / / Phone # Authorized to sell cars? YES NO Authorized to sign checks? YES NO Account Holder's Signature: Authorized to sign drafts? YES NO Date: / / Phone # Representative: Signature: SS#: DOB: / / Phone # Authorized to sell cars? YES NO Authorized to sign checks? YES NO Account Holder's Signature: Authorized to sign drafts? YES NO Date: / / Phone # GUARANTY In consideration of Auction allowing Dealer to buy and sell motor vehicles through Auction, the undersigned, whether one or more, personally covenant, guarantee and warrant the title to each vehicle sold by Dealer through Auction will be good and will be free and clear of all liens and encumbrances, whatsoever. The undersigned unconditionally agrees to reimburse Auction for any loss, damage, expense, or costs, including attorney's fees, incurred by Auction as a result of breach of the foregoing warranty of title as to any such motor vehicle. The undersigned further personally guarantees full payment of any debts of Dealer to Auction, including any checks or drafts issued by Dealer or any of Dealer's representatives, together with any loss or expense incurred by Auction in collecting or attempting to collect such debt, including attorney's fees. The undersigned acknowledges that Auction shall have the right to refuse to transact business with Dealer or the undersigned, to modify or release any and all collateral security, to extend or change time of payment and to settle or compromise with Dealer without notice to the undersigned and without discharging or affecting the liability of the undersigned hereunder. This guaranty is to be a continuing guaranty and the undersigned hereby waives notice of acceptance of this guaranty and presentment, demand, protest, and any notice of non-payment or dishonor. The undersigned shall be liable as principal debtor and not merely as surety, and the bankruptcy or any assignment in favor of Creditors of Dealer shall not affect the enforceability of this agreement. Auction's impairment of any security for Dealer's obligations shall not discharge in whole or in part this guarantee. This instrument shall bind the respective heirs, executors and administrators, and assigns of the undersigned, and shall inure to the benefit of Auction, its successors, assigns, and subrogees. Where there is more than one signatory to this agreement each signatory shall be jointly and severally liable under the agreement. IN WITNESS WHEREOF the undersigned have hereunto set their hands and seals this Day of, 20. WITNESS WITNESS WITNESS

6 Dealer Name: Date: / / Bank Name: Account Number: Bank Address: City ST Zip Bank Phone: ( ) Bank Fax: ( ) To Whom it May Concern: I have listed your financial institution as Dealer's principal banking reference for Value Auto Auction (VAA). VAA is a wholesale vehicle auction for licensed new and used motor vehicle dealers and repossessed vehicles. I authorize the release of the information requested below. This data is for VAA's internal purposes only and will be kept strictly confidential. Your prompt reply is appreciated. If you have any questions, please feel free to contact VAA by phone, fax, or listed at the top of this page. I hereby grant my ongoing written consent to VAA to run a credit check and obtain a credit report, consumer report, or investigative consumer report from any source on my dealership and me personally. I also give consent to the bank listed above to release Dealer's credit information to VAA. Any charges associated with these services should be billed directly to me, the account holder. Regards, Authorized Printed Name: Authorized Signature: Checking Account: OPEN DATE AVERAGE BALANCE CURRENT BALANCE RELATIONSHIP Other Accounts OPEN DATE TYPE AVERAGE BALANCE CURRENT BALANCE RELATIONSHIP Number of Returned Checks: Line of Credit: Available Balance: Banker's Signature: Title: Printed Name: Date: / /

7 Commercial Blanket Power of Attorney Company Name: Date: / / While transacting business with the Value Auto Auction LLC. in Crooksville, Ohio, I hereby appoint the following company representative(s) as my attorney in fact to sign all motor vehicle documents relating to title and registration transactions for said company. Value Auto Auction Representatives Form remains on file with Value Auto Auction LLC until withdrawn or a replacement form is provided by the company. A replacement form is the company's sole responsibility and must be resubmitted when changes to this authorization are desired. Company Name: Printed Name: Signature: Owner President Vice President Other: Address: City: State Zip Business: Phone Number: ( ) State of Ohio Personally appeared before me, the undersigned authority, with whom I am personally acquainted, who acknowledged that the foregoing instrument was executed for the purpose therein contained, on this day of,. Day Month Year Notary Public SS: My Commission Expires: / /

8 FAX CONSENT FORM In order for Value Auto Auction to be compliant with the recent Federal Communication Commission regulations, we must obtain expressed written consent from our customers and business partners in order to call and transmit faxes and/or s. Please have the appropriate person in your company fill out this form and fax it back to us as soon as possible. Thank you for your continue business with us. Company/Organization for which consent is being provided: Name of person authorized to give such consent: Phone number(s) for which this consent is being provided: Fax number(s) for which this consent is being provided: s for which this consent is being provided: I understand that by providing the fax number(s) and or (s) above on behalf of the customer/business partner specified above, I am authorized to and hereby consent for the customer/business partner to receive faxes and s sent by, or on behalf of Value Auto Auction. SIGNATURE: DATE: / /

9 ("Dealer") [Dealer Name] PERSONAL GUARANTY In consideration of Auction allowing Dealer to buy and sell motor vehicles through Auction, the undersigned whether one or more, personally covenants, guarantees and warrants the title of each vehicle sold by Dealer through Auction will be valid and will be free and clear of all liens and encumbrances, whatsoever. The undersigned unconditionally agrees to reimburse Auction for any losses, damages, expenses or costs, including attorney's fees, incurred by Auction as a result of any breach of the foregoing warranty of title as to any such motor vehicle. The undersigned further guarantees full payment of Dealer's debts to Auction, including any checks or drafts issued by Dealer or any of Dealer's representatives, together with any losses or expenses incurred by Auction in collecting or attempting to collect such debt, including attorney's fees. The undersigned further personally guarantees the Odometer Mileage Statements given by or on behalf of the Dealer in all sales of motor vehicles by Dealer through Auction, and agrees to indemnify and hold harmless the Auction from all losses and expenses caused it by any such Odometer Mileage Statement including without limitation: (1) payments made by the auction under any Odometer Protection Program it may establish in connection with any vehicle sale, (2) any amount paid in settlement of any claim in connection with any such odometer complaint or problem (3) any amounts paid as damages for any odometer claim, including any punitive damages, and (4) any expense or costs incurred by Auction in defending any odometer claims in connection with Dealer's sales or collecting or attempting to collect any losses, including attorney's fees. The undersigned acknowledges that Auction shall have the right to refuse to transact business with the Dealer or the undersigned, to modify, extend or change time of payment to settle with Dealer, to release any and all collateral or security, without notice to the undersigned and without discharging or affecting the liability of the undersigned herein. This guaranty is to be a continuing guaranty and the undersigned hereby waives notice of acceptance of this guaranty, presentment, demand, and not merely as surety, and the bankruptcy or any assignment in favor of the Creditors of Dealer shall not affect the enforceability of this agreement, Auction's impairment of any security or collateral to Dealer's obligation shall not discharge, in whole or in part, this guarantee. This Guaranty shall hind the respective heirs, executors, administrators, and assigns of the undersigned, and shall inure the benefit of the Auction, its successors, assigns and subrogees. Where there is more than one signatory to this agreement, each signatory agrees to be jointly and severally liable under this agreement. GUARANTOR: (Print) (Sign) GUARANTOR: (Print) (Sign) GUARANTOR: (Print) (Sign) DATE: / /

10 Value Auto Auction Is the Fastest Growing Auto Auction in the Midwest

Dealer Registration. Credit Information

Dealer Registration. Credit Information Dealer Registration Business Name Trade Name Primary Contact: Secondary Contact: Dealer Type: New Used Franchises Held Business Type: Sole Proprietorship Corporation: Subchapter C Subchapter S Limited

More information

PO Box 420 Alcoa, TN Date: Dealer Name: Date Organized: Type of Business: Ind. Corp. Partnership New Used Wholesale Request to: Buy Sell Both

PO Box 420 Alcoa, TN Date: Dealer Name: Date Organized: Type of Business: Ind. Corp. Partnership New Used Wholesale Request to: Buy Sell Both Thank you for your interest in doing business at Airport Auto Auction. Here is a registration package for your convenience which upon completion can be faxed back to us at 865-970-9603 or e-mail to krissybradford@airportautoauction.com.

More information

**Please provide your 7 or 9 digit Auction Access #: Guaranty

**Please provide your 7 or 9 digit Auction Access #: Guaranty 5937 Sandy Hollow Road Rockford, IL 61109 800-830-4722 DEALER REGISTRATION PACKET FOR THOSE WHO HAVE AUCTION ACCESS # **Please provide your 7 or 9 digit Auction Access #: Guaranty In consideration of Greater

More information

ADDENDUM TO DEALER AGREEMENT

ADDENDUM TO DEALER AGREEMENT ADDENDUM TO DEALER AGREEMENT This Addendum to Dealer Agreement is entered into as of this day of,, for the benefit of R.C. Mast, INC.. (hereinafter referred to as ASC ), by (hereinafter referred to as

More information

Statewide Auto Auction 1756 North Broad St Meriden, CT P: F:

Statewide Auto Auction 1756 North Broad St Meriden, CT P: F: Application/Agreement Supplement Statewide Dealer #: Legal Name of Business Trade Name of Business Street: City: State: Zip: Phone: Fax: Dealership email: Dealer License Plate #: Owner Name: Owner Cell:

More information

Registration Application

Registration Application Registration Application Dealership Information Dealership AuctionACCESS ID: Trade or DBA Name: Legal Name (if different): Date Business Started: Federal ID: RIN (Canadian Province of Ontario only): (US-EIN,

More information

Co-Applicant. Phone. Fax. Business Information

Co-Applicant. Phone. Fax. Business Information Applicant Legal Business List all trade names and D.B.A. if applicable Parent if applicant is a subsidiary Amount of Credit Requested: Will you furnish a financial statement upon request? Purchase Order

More information

BUSINESS REWARDS CREDIT CARD AGREEMENT (TO BE USED FOR CORPORATIONS, PARTNERSHIPS, LLCs, SERVICE ORGANIZATIONS OR OTHER BUSINESSES)

BUSINESS REWARDS CREDIT CARD AGREEMENT (TO BE USED FOR CORPORATIONS, PARTNERSHIPS, LLCs, SERVICE ORGANIZATIONS OR OTHER BUSINESSES) BUSINESS REWARDS CREDIT CARD AGREEMENT (TO BE USED FOR CORPORATIONS, PARTNERSHIPS, LLCs, SERVICE ORGANIZATIONS OR OTHER BUSINESSES) This AGREEMENT made and entered into this day of, 20, by and between

More information

BECK EQUIPMENT, INC Preble Rd, Preble, NY Toll Free: (866) / Fax: (607)

BECK EQUIPMENT, INC Preble Rd, Preble, NY Toll Free: (866) / Fax: (607) Legal Company Name BECK EQUIPMENT, INC. RENTAL APPLICATION To apply for rentals from Beck Equipment, Inc., please provide the following information. Fill out completely and return by fax to (607) 749-5640.

More information

Thank you for your interest in signing up with Greater Access Financial. Enclosed you will find the following:

Thank you for your interest in signing up with Greater Access Financial. Enclosed you will find the following: 1766 W. San Carlos Street San Jose, CA 95128 408-282-9931 phone 408-282-9932 fax Thank you for your interest in signing up with Greater Access Financial. Enclosed you will find the following: Dealer Application

More information

PROMISSORY NOTE TERM TABLE. BORROWER S PRINCIPAL (manager):

PROMISSORY NOTE TERM TABLE. BORROWER S PRINCIPAL (manager): PROMISSORY NOTE TERM TABLE PRINCIPAL (loan amount): ORIGINATION DATE: BORROWER: INTEREST (annualized): MATURITY DATE: BORROWER S PRINCIPAL (manager): ADDRESS: LIEN: First priority lien. Second priority

More information

CREDIT APPLICATION / APPLICANT AGREEMENT

CREDIT APPLICATION / APPLICANT AGREEMENT CREDIT APPLICATION / APPLICANT AGREEMENT This Credit Application / Applicant Agreement (the Application ) is between Lubbock Rent All & Supply, LLC ( LRA ), and the applicant named on page one below (

More information

Registration Application

Registration Application Registration Application Dealership Information Trade or DBA Name: Legal Name (if different): Date Business Started: Federal ID: RIN (Canadian Province of Ontario only): (US-EIN, MX-RFC, CA-GST/BIN, International-Owners

More information

LOAN AGREEMENT. WHEREAS, Lender intends to provide, and Borrower intends to receive, a loan upon the terms and conditions hereinafter set forth,

LOAN AGREEMENT. WHEREAS, Lender intends to provide, and Borrower intends to receive, a loan upon the terms and conditions hereinafter set forth, LOAN AGREEMENT This loan agreement (the Agreement ), entered into as of Month Day, Year, is hereby made by and between the Parties stated below (each a Party ). WITNESSETH: WHEREAS, Lender intends to provide,

More information

*SLA LICENSE SERIAL #: *NY STATE TAX ID #:

*SLA LICENSE SERIAL #: *NY STATE TAX ID #: SOUTHERN GLAZER S WINE & SPIRITS OF UPSTATE NEW YORK, LLC P.O. BOX 4705 SYRACUSE, NEW YORK 13221-4705 PHONE: (315) 428-2100 FAX: (315) 410-5463 ACCOUNT # For office use only APPLICATION AND CREDIT AGREEMENT

More information

Alaska Ship Supply Dutch Harbor / Captains Bay A division of Western Pioneer, Inc.

Alaska Ship Supply Dutch Harbor / Captains Bay A division of Western Pioneer, Inc. Alaska Ship Supply Dutch Harbor / Captains Bay A division of Western Pioneer, Inc. Corporate Office PO Box 70438 Seattle, WA 98127-0438 (206) 789-1930 (800) 426-6783 Fax (206) 784-8348 COMMERCIAL BUSINESS

More information

Kansas Credit Services Organization Instructions for Application of Registration

Kansas Credit Services Organization Instructions for Application of Registration STATE OF KANSAS OFFICE OF THE STATE BANK COMMISSIONER CONSUMER AND MORTGAGE LENDING DIVISION 700 SW Jackson St., Suite 300 Topeka, Kansas 66603-3796 785-296-2266 Fax: 785-296-6037 Kansas Credit Services

More information

Small Business Credit Card New Business Credit Card Account Relationship

Small Business Credit Card New Business Credit Card Account Relationship Small Business Credit Card New Business Credit Card Account Relationship New Account Opening Packet Contents 1. Mastercard BusinessCard Application (required for each applicant) 2. Certification & Directive

More information

New Customer Package. Credit Application Contact Sheet Insurance Requirements (with example)

New Customer Package. Credit Application Contact Sheet Insurance Requirements (with example) New Customer Package Credit Application Contact Sheet Insurance Requirements (with example) Please fill out the downloaded forms and provide a certificate of insurance complying with all of the requirements

More information

APPLICATION FOR BUSINESS CREDIT

APPLICATION FOR BUSINESS CREDIT _. Return Completed Application to: Pike Industries, Inc. 3 Eastgate Park Road Belmont, NH 03220 Phone: 603.527.5100 Fax: 603.527.5101 Email: r1arremit@pikeindustries.com APPLICATION FOR BUSINESS CREDIT

More information

UNIFORM SALES & USE TAX EXEMPTION/RESALE CERTIFICATE MULTIJURISDICTION

UNIFORM SALES & USE TAX EXEMPTION/RESALE CERTIFICATE MULTIJURISDICTION UNIFORM SALES & USE TAX EXEMPTION/RESALE CERTIFICATE MULTIJURISDICTION The below-listed states have indicated that this certificate is acceptable as a resale/exemption certificate for sales and use tax,

More information

Registration Application

Registration Application Registration Application Dealership Information Dealership AuctionACCESS ID: Trade or DBA Name: Legal Name (if different): Date Business Started: Federal ID: RIN (Canadian Province of Ontario only): (US-EIN,

More information

Standard Credit Package Attn: Brenda Koch Ph.:

Standard Credit Package Attn: Brenda Koch Ph.: Standard Credit Package Attn: Brenda Koch Ph.: 281.597.5479 In order to expedite your request, please include the following: 1. A completed and signed credit application. If you have your credit information

More information

STARTUPCO LLC MEMBERSHIP INTEREST SUBSCRIPTION AGREEMENT

STARTUPCO LLC MEMBERSHIP INTEREST SUBSCRIPTION AGREEMENT STARTUPCO LLC MEMBERSHIP INTEREST SUBSCRIPTION AGREEMENT This MEMBERSHIP INTEREST SUBSCRIPTION AGREEMENT (the "Agreement") is entered into by and between STARTUPCO LLC, a limited liability company (the

More information

PLEASE. To Process your Application we must have the following:

PLEASE. To Process your Application we must have the following: PLEASE To Process your Application we must have the following: Complete and return the entire application. An Owner/Principle/Officer must sign. Please include a copy of Photo ID for the parties signing

More information

Mailing Address: City: State: Zip: (If different than above) Name: SS#: DOB: Printed Name: Title:

Mailing Address: City: State: Zip: (If different than above) Name: SS#: DOB: Printed Name: Title: C#: Page 1 of 5 PC: Revised 07/11 Salesman: FERGUSON SUPPLY COMPANY COMPANY / OWNER(S) INFORMATION: Company Name: Street Address: City: State: Zip: Business / Home Phone: Cell Phone: Fax: Email Address:

More information

LOAN AGREEMENT R E C I T A L S

LOAN AGREEMENT R E C I T A L S LOAN AGREEMENT This Loan Agreement (the Agreement ) is made and effective the 13th of January, 2012 (the Effective Transaction Date ), BETWEEN: AND: THE ONE SOURCE ENTERPRISES, LLC, a limited liability

More information

MINNESOTA STATE LOTTERY SECURITY DEPOSIT REQUIREMENTS

MINNESOTA STATE LOTTERY SECURITY DEPOSIT REQUIREMENTS MINNESOTA STATE LOTTERY SECURITY DEPOSIT REQUIREMENTS applicants who do not have a favorable credit history are required to maintain a security deposit for a minimum of six months. The security deposit

More information

FILED: NEW YORK COUNTY CLERK 01/30/ :10 AM INDEX NO /2017 NYSCEF DOC. NO. 24 RECEIVED NYSCEF: 01/30/2018

FILED: NEW YORK COUNTY CLERK 01/30/ :10 AM INDEX NO /2017 NYSCEF DOC. NO. 24 RECEIVED NYSCEF: 01/30/2018 Exhibit D ME1 25464178v.l GUARANTY In consideration of financial accommodations given or to be given or continued to Jailaxmi "Borrower" Taxi Inc., (the "Borrower"), by FIRST JERSEY CREDIT UNION, a state

More information

Direct Deposit Setup Instructions:

Direct Deposit Setup Instructions: Direct Deposit Setup Instructions: 1. Provide IRS Letter of Incorporation or State Business Registration Certificate. 2. Complete the following forms for the Company setup, please ensure that you sign

More information

PLEASE. To Process your Application we must have the following:

PLEASE. To Process your Application we must have the following: PLEASE To Process your Application we must have the following: Complete and return the entire application. An Owner/Principle/Officer must sign. Please include a copy of Photo ID for the parties signing

More information

C O M M E R C I A L C R E D I T A P P L I C A T I O N

C O M M E R C I A L C R E D I T A P P L I C A T I O N PLEASE CHECK SITE LOCATIONS BELOW C O M M E R C I A L C R E D I T A P P L I C A T I O N Office: 907-276-2688 Toll Free: 800-478-2688 Fax: 907-276-374 l Anchorage Bethel Dillingham Dutch Harbor Fairbanks

More information

CLASSIFIED ;

CLASSIFIED ; CLASSIFIED 4146.1; 4246.1 TAX SHELTERED ACCOUNTS This plan is hereby adopted by the San Dieguito Union High School District (hereinafter called the district ). As permitted by law, the Board shall allow

More information

VANTU BANK LIMITED. Financial Asset Trade Agreement

VANTU BANK LIMITED. Financial Asset Trade Agreement VANTU BANK LIMITED Client Account Number: Asset Number(s): The undersigned, [hereinafter Client ] hereby appoints Vantu Bank Limited [hereinafter Vantu Bank ] to act as custodian for the purpose of wealth

More information

Welcome to Monoprice, Inc.

Welcome to Monoprice, Inc. Welcome to Monoprice, Inc. Enclosed is Monoprice, Inc. Account Application Form. Please complete the application form and send it back to our sales department. Once you have become our customer, you can

More information

LICENSE & PERMIT BOND APPLICATION Note: If applying for an ARC or Seller of Travel bond-see attached Rider.

LICENSE & PERMIT BOND APPLICATION Note: If applying for an ARC or Seller of Travel bond-see attached Rider. NICHOLAS A.HANLEY LIC#: W062005 LICENSE & PERMIT BOND APPLICATION Note: If applying for an ARC or Seller of Travel bond-see attached Rider. Please Note: This application is for individual applicants or

More information

MARYLAND AUTO PRODUCER CODE: (Maryland Auto use only) APPLICATION FOR AUTHORITY TO TRANSACT MARYLAND AUTOMOBILE INSURANCE FUND BUSINESS

MARYLAND AUTO PRODUCER CODE: (Maryland Auto use only) APPLICATION FOR AUTHORITY TO TRANSACT MARYLAND AUTOMOBILE INSURANCE FUND BUSINESS 1. AGENCY NAME: LEGAL NAME: MARYLAND AUTO PRODUCER CODE: (Maryland Auto use only) APPLICATION FOR AUTHORITY TO TRANSACT MARYLAND AUTOMOBILE INSURANCE FUND BUSINESS Name on license and bond must read the

More information

Name of Individual or Legal Entity Responsible for Payment. City State Zip City State Zip. Phone Number Fax Number Phone Number Fax Number

Name of Individual or Legal Entity Responsible for Payment. City State Zip City State Zip. Phone Number Fax Number Phone Number Fax Number 2801 Horace Shepard Drive Dothan, AL 36303 1. Account Information APPLICATION FOR NEW ACCOUNT The following is an application for credit with ONCOLOGY SUPPLY, also known as creditor within the general

More information

Participating Dealer Financing Agreement with Collins Community Credit Union

Participating Dealer Financing Agreement with Collins Community Credit Union Participating Dealer Financing Agreement with Collins Community Credit Union THIS AGREEMENT ( Agreement ) is entered into between, hereinafter referred to as Dealer, and Collins Community Credit Union,

More information

Electricity Supplier - Billing Services Agreement

Electricity Supplier - Billing Services Agreement Electricity Supplier - Billing Services Agreement THIS BILLING SERVICES AGREEMENT ( Agreement ) is made as of the day of, 20, ( Effective Date ) by and between BALTIMORE GAS AND ELECTRIC COMPANY ( BGE

More information

NATIONAL INSURANCE UNDERWRITERS, LLC. AUTO PRODUCER S AGREEMENT

NATIONAL INSURANCE UNDERWRITERS, LLC. AUTO PRODUCER S AGREEMENT NATIONAL INSURANCE UNDERWRITERS, LLC. AUTO PRODUCER S AGREEMENT This Agreement between National Insurance Underwriters, LLC., with principle offices located at 800 Yamato Road, Suite 100, Boca Raton, FL

More information

FILED: NEW YORK COUNTY CLERK 08/14/ :36 PM INDEX NO /2015 NYSCEF DOC. NO. 22 RECEIVED NYSCEF: 08/14/2015. Exhibit C

FILED: NEW YORK COUNTY CLERK 08/14/ :36 PM INDEX NO /2015 NYSCEF DOC. NO. 22 RECEIVED NYSCEF: 08/14/2015. Exhibit C FILED: NEW YORK COUNTY CLERK 08/14/2015 10:36 PM INDEX NO. 652346/2015 NYSCEF DOC. NO. 22 RECEIVED NYSCEF: 08/14/2015 Exhibit C For Lender use only: Received by: Approved by: Other: CAPITAL ONE TAXI MEDALLION

More information

Royal Group, Inc. or Royal Plastics Group USA Group Company name CREDIT APPLICATION

Royal Group, Inc. or Royal Plastics Group USA Group Company name CREDIT APPLICATION Royal Group, Inc. or Royal Plastics Group USA Group Company name CREDIT APPLICATION Tel:( 905) 652 2780 Fax:( 905) 652 8003 New Application For which Royal Group Company Credit Update Please select the

More information

FireFold Account and Credit Application

FireFold Account and Credit Application Payment is due 30 days from billing date. All overdue balances shall accrue interest at a rate of 1.5 % per month until invoice is PIF. A $5.00 Processing Fee will be accessed to purchase orders less than

More information

Retail Collateral Mortgage

Retail Collateral Mortgage Page 1 Retail Collateral Mortgage You,, being registered as owner(s of an estate in fee simple subject, however, to such encumbrances, liens and interests as are notified by memorandum underwritten or

More information

(This Agreement supersedes all prior Agreements) AGREEMENT

(This Agreement supersedes all prior Agreements) AGREEMENT (This Agreement supersedes all prior Agreements) AGREEMENT AGREEMENT, dated day of, 20, between International Transportation & Marine Agency, Inc., a corporation organized and existing under and by virtue

More information

Baltimore Gas and Electric Company Gas Supplier - Billing Services Agreement

Baltimore Gas and Electric Company Gas Supplier - Billing Services Agreement Baltimore Gas and Electric Company Gas Supplier - Billing Services Agreement THIS BILLING SERVICES AGREEMENT ( Agreement ) is made as of the day of, 20, ( Effective Date ) by and between BALTIMORE GAS

More information

Application for License, Permit and Miscellaneous Bonds BOND INFORMATION

Application for License, Permit and Miscellaneous Bonds BOND INFORMATION Surety Group Application for License, Permit and Miscellaneous Bonds A BOND INFORMATION Bond Number: TYPE OF BOND BOND AMOUNT REQUESTED EFFECTIVE DATE BOND TO BE FILED WITH (OBLIGEE) ADDRESS OF OBLIGEE

More information

CADA DEALER BOND INSTRUCTIONS

CADA DEALER BOND INSTRUCTIONS CADA DEALER BOND INSTRUCTIONS 1) Complete Pages 1-2: CADA DEALER Bond Application (*Required) 2) Complete Pages 3-4 : HCC Colorado Application for License, Permit and Misc Bonds (*Required) Page 3 : Section

More information

ORIGINAL SIGNED CREDIT APPLICATION ON ALL SIGNERS (SIGNED AND DATED) BUYER S ORDER (WITH ALL EQUIPMENT AND ACCESSORIES LISTED AND VEHICLE COLOR)

ORIGINAL SIGNED CREDIT APPLICATION ON ALL SIGNERS (SIGNED AND DATED) BUYER S ORDER (WITH ALL EQUIPMENT AND ACCESSORIES LISTED AND VEHICLE COLOR) Lien Holder & Loss Payee : HONOR FINANCE CORP. P.O. Box 1817 Evanston, IL 60204 Physical : HONOR FINANCE CORP. 30575 Bainbridge Rd, Suite 150 Solon, OH 44139 Phone: (216) 694-8974 Fax: (440) 318-1163 www.honorfinance.com

More information

, ( Occupant ). Occupant s Initials Occupant s Initials

, ( Occupant ). Occupant s Initials Occupant s Initials 48 MEDINA LINE ROAD, LLC SELF SERVICE STORAGE AGREEMENT This lease agreement ( Lease ) is executed on this day of, 20 between 48 Medina Line Road, LLC ( Owner ) and, ( Occupant ). WITNESSETH: 1. DESCRIPTION

More information

AUTHORIZED INDEPENDENT AGENCY APPLICATION (PAGE 1)

AUTHORIZED INDEPENDENT AGENCY APPLICATION (PAGE 1) AUTHORIZED INDEPENDENT AGENCY APPLICATION (PAGE 1) Name of Brokerage or Agency as Licensed Date Address (street, city, state, zip) Telephone Mailing Address or "Trade Name" if Different than Above Individual

More information

STG Indemnity Agreement

STG Indemnity Agreement STG Indemnity Agreement INDEMNITY AGREEMENT 1 This indemnification is made and given by: referred to herein as "Indemnitor" (whether one or more) for the benefit of Stewart Title Guaranty Company and (individually

More information

WELLS FARGO EXHIBIT 10.4 CONTINUING SECURITY AGREEMENT RIGHTS TO PAYMENT AND INVENTORY

WELLS FARGO EXHIBIT 10.4 CONTINUING SECURITY AGREEMENT RIGHTS TO PAYMENT AND INVENTORY EXHIBIT 10.4 WELLS FARGO CONTINUING SECURITY AGREEMENT RIGHTS TO PAYMENT AND INVENTORY 1. GRANT OF SECURITY INTEREST. For valuable consideration, the undersigned S&W SEED COMPANY, or any of them ("Debtor"),

More information

GRAND RAPIDS CRANE CO LLC.

GRAND RAPIDS CRANE CO LLC. GRAND RAPIDS CRANE CO LLC. New Customer Application Contents: 1. Index 2. Application of Credit 3. Application of Credit 4. Application of Credit Please Email or Fax completed form to justin@grandrapidscrane.com

More information

Self-Insurance Package for an Individual

Self-Insurance Package for an Individual Self-Insurance Package for an Individual Bureau of Motor Vehicles Financial Responsibility Section P.O. Box 68674 Harrisburg, PA 17106-8674 Phone: (717) 783-3694 www.dmv.pa.gov PUB 620 (12-15) Preface

More information

VSC / GAP ADMINISTRATOR & PROVIDER AGREEMENT

VSC / GAP ADMINISTRATOR & PROVIDER AGREEMENT For office use only: VSC company number: GAP company number: VSC / GAP ADMINISTRATOR & PROVIDER AGREEMENT Company Federal Tax ID # Effective Date Address City State ZIP Telephone Number Fax Number Contact

More information

Farmers State Bank of Calhan Visa Business Credit Card Application

Farmers State Bank of Calhan Visa Business Credit Card Application Farmers State Bank of Calhan Visa Business Credit Card Application APPLYING FOR: (Please Print) Visa Business Card Visa Fleet Card Total Credit Limit Requested:$ Total Credit Limit Requested:$ If company

More information

SAMPLE VEHICLE LEASE AGREEMENT. THIS VEHICLE LEASE AGREEMENT dated the day of, 19 BETWEEN:

SAMPLE VEHICLE LEASE AGREEMENT. THIS VEHICLE LEASE AGREEMENT dated the day of, 19 BETWEEN: SAMPLE VEHICLE LEASE AGREEMENT THIS VEHICLE LEASE AGREEMENT dated the day of, 19 BETWEEN: AND: BRITISH COLUMBIA TRANSIT, a corporation incorporated pursuant to the British Columbia Transit Act, (hereinafter

More information

Dealer Profile Information

Dealer Profile Information Dealer Checklist/Profile Sheet: 2017 Dealership Name: The following checklist is to ensure that you fill out and send back the correct paperwork to Global Lending Services. If you have any questions, please

More information

SAMPLE GUARANTY BOND WHEREAS, A proprietary business school, or proprietary trade school or proprietary technical school, or

SAMPLE GUARANTY BOND WHEREAS, A proprietary business school, or proprietary trade school or proprietary technical school, or STATE OF NORTH CAROLINA COUNTY OF GUARANTY BOND KNOW ALL PERSONS BY THESE PRESENT THAT: WHEREAS, A proprietary business school, or proprietary trade school or proprietary technical school, or correspondence

More information

Case LSS Doc Filed 04/29/16 Page 1 of 7. Exhibit A. First Amendment to DIP Credit Agreement

Case LSS Doc Filed 04/29/16 Page 1 of 7. Exhibit A. First Amendment to DIP Credit Agreement Case 16-10882-LSS Doc 242-1 Filed 04/29/16 Page 1 of 7 Exhibit A First Amendment to DIP Credit Agreement 01:18631850.2 Case 16-10882-LSS Doc 242-1 Filed 04/29/16 Page 2 of 7 FIRST AMENDMENT TO DEBTOR-IN-POSSESSION

More information

DealerTrack/RouteOne ID #: Copy of: Dealer Agreement Installment Seller s License Dealer ACH agreement DMV License Surety Bond.

DealerTrack/RouteOne ID #: Copy of: Dealer Agreement Installment Seller s License Dealer ACH agreement DMV License Surety Bond. U DRIVE ACCEPTANCE CORP - FRANCHISE DEALER APPLICATION 1119 4 TH St., Suite 102, Sioux City, IA 51101 P: 712.258.0269 F: 712.224.5165 To qualify as an approved U Drive Acceptance Corp, dealership the following

More information

REVOLUTION LIGHTING TECHNOLOGIES, INC. (Exact name of registrant as specified in its charter)

REVOLUTION LIGHTING TECHNOLOGIES, INC. (Exact name of registrant as specified in its charter) UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 8-K CURRENT REPORT Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Date of Report (Date of earliest event

More information

BIDDER REGISTRATION PACKET FOR HIGHWAY 51 CLASSIC CAR AUCTION

BIDDER REGISTRATION PACKET FOR HIGHWAY 51 CLASSIC CAR AUCTION BIDDER REGISTRATION PACKET FOR HIGHWAY 51 CLASSIC CAR AUCTION IN ORDER TO BID AT THE HIGHWAY 51 CLASSIC CAR AUCTION, PLEASE PROVIDE THE FOLLOWING... 1) SIGNED HIGHWAY 51 AUCTION REGISTRATION & BIDDER AGREEMENT

More information

INSTRUCTIONS FOR APPLICATION FOR ASSIGNMENT OF CAPITAL CREDITS FOR BUSINESS OR ENTITY NO LONGER IN EXISTENCE

INSTRUCTIONS FOR APPLICATION FOR ASSIGNMENT OF CAPITAL CREDITS FOR BUSINESS OR ENTITY NO LONGER IN EXISTENCE INSTRUCTIONS FOR APPLICATION FOR ASSIGNMENT OF CAPITAL CREDITS FOR BUSINESS OR ENTITY NO LONGER IN EXISTENCE When to Use this Application: This application is to be used when Miami-Cass REMC (the Cooperative

More information

Credit Application Fax to: to:

Credit Application Fax to: to: Credit Application Fax to: 215.618.0786 Email to: creditapps@pjponline.com CUSTOMER TRADE NAME FULL LEGAL BUSINESS NAME PHYSICAL ADDRESS CITY STATE ZIP Federal Tax I.D. #: MAILING ADDRESS CITY STATE ZIP

More information

CREDIT APPLICATION. Billing Address City: State: Zip: Shipping Address City: State: Zip: DBA: Established:

CREDIT APPLICATION. Billing Address City: State: Zip: Shipping Address City: State: Zip: DBA: Established: KONA FISH COMPANY, INC. 55 Holomua St. ~ Hilo, Hawaii 96720 Phone: (808) 961-0877 ~ Fax: (808) 934-8783 Email: accounting@konafish.com ~ Internet: www.konafish.com Requested Credit Limit: CREDIT APPLICATION

More information

FUNDING CHECK LIST. Dealer Name: Borrower(s) Name(s):

FUNDING CHECK LIST. Dealer Name: Borrower(s) Name(s): FUNDING CHECK LIST Dealer Name: Borrower(s) Name(s): Documents Provided by ROAD: Assignment of Retail Installment Contract and Guarantee of Title Addendum to Installment Contract Ancillary Product Checklist

More information

*** N E W O P E N A C C O U N T A P P L I C A T I O N * * *

*** N E W O P E N A C C O U N T A P P L I C A T I O N * * * *** N E W O P E N A C C O U N T A P P L I C A T I O N * * * Are you applying for a Business Account or Personal Account? To expedite the processing of your application please include copies of all documents

More information

WISCONSIN WEALTH ADVISORS, LLC WEALTH MANAGEMENT SERVICES AGREEMENT. This Agreement for wealth management services is made between

WISCONSIN WEALTH ADVISORS, LLC WEALTH MANAGEMENT SERVICES AGREEMENT. This Agreement for wealth management services is made between WISCONSIN WEALTH ADVISORS, LLC WEALTH MANAGEMENT SERVICES AGREEMENT This Agreement for wealth management services is made between ( Client ) and Wisconsin Wealth Advisors, LLC ( Adviser ). Client hereby

More information

Commercial Credit Application

Commercial Credit Application Return completed application to: Credit@bluewaterindustries.com Commercial Credit Application Customer s Business Name Fictitious name(s) used Street Address Mailing Address, if different City State Zip

More information

**For Your Convenience We Also Accept Checks By Fax And Credit Card Payments**

**For Your Convenience We Also Accept Checks By Fax And Credit Card Payments** Revised 10-27-2014 SIGNATURE SPRINGS, LLC B I L L ATTENTION Account Information Form S H I P LEGAL BUSINESS NAME ADDRESS T O TRADE NAME KITCHEN CONTACT ADDRESS T O CITY, STATE, ZIP ACCOUNTING CONTACT PHONE

More information

Self-Insurance Package for a Corporation

Self-Insurance Package for a Corporation Self-Insurance Package for a Corporation Bureau of Motor Vehicles Financial Responsibility Section P.O. Box 68674 Harrisburg, PA 17106-8674 Phone: (717) 783-3694 www.dmv.pa.gov PUB 618 (12-15) Preface

More information

Business Account Application

Business Account Application Date Account Number Customer Identification Requirements: To help the government fight the funding of terrorism and money laundering activities, Federal laws require all financial institutions to obtain,

More information

New Dealer Enrollment

New Dealer Enrollment Foundation Finance Program New Dealer Enrollment Enrollment Checklist To ensure your application is processed within two business days, please attach all the supporting items below. Complete Attach Include

More information

Fall River Office of Economic Development Small Business Administration (SBA) Microloan Program

Fall River Office of Economic Development Small Business Administration (SBA) Microloan Program Fall River Office of Economic Development Small Business Administration (SBA) Microloan Program BACKGROUND: Fall River Office of Economic Development (FROED) established this assistance program with funds

More information

CARRIER ENTERPRISE NORTHEAST, LLC ( CE ) (PLEASE PRINT CLEARLY) Credit Agreement

CARRIER ENTERPRISE NORTHEAST, LLC ( CE ) (PLEASE PRINT CLEARLY) Credit Agreement CARRIER ENTERPRISE NORTHEAST, LLC ( CE ) Date Credit Agreement (PLEASE PRINT CLEARLY) Company Name of Applicant (If applicant is a corporation or LLC, give name as it appears in the ARTICLES OF INCORPORATION)

More information

SELECT SOURCE TERMS AND CONDITIONS

SELECT SOURCE TERMS AND CONDITIONS SELECT SOURCE TERMS AND CONDITIONS In the course of its business, Reseller will purchase Ingram Micro Products and will sell Ingram Micro Products to customers located in the United States ( End Users

More information

Our standard terms are ½ percent 10, net 30 days. Please remit all payments to: AMERICAN METAL SUPPLY CO. PO BOX MIDDLETOWN, OH

Our standard terms are ½ percent 10, net 30 days. Please remit all payments to: AMERICAN METAL SUPPLY CO. PO BOX MIDDLETOWN, OH 11337 Williamson Rd. Cincinnati, OH 45241 513/396-6600 800/541-4430 Fax 513/396-6079 BILL R. GUY President November 10, 2015 On behalf of American Metal Supply we welcome your application for trade credit.

More information

November 6, 2017 [SAOPAULO 9744_4]

November 6, 2017 [SAOPAULO 9744_4] CONSENT AND LETTER OF TRANSMITTAL To Deliver Consents and to Tender Notes to SUZANO TRADING LTD. (an exempted company incorporated with limited liability in the Cayman Islands) Relating to the Offer to

More information

RECORDING COVER SHEET. Title of Document: Date of Document: Grantors: Grantee(s): Mailing Address(es): Reference Book and Page: Doc.

RECORDING COVER SHEET. Title of Document: Date of Document: Grantors: Grantee(s): Mailing Address(es): Reference Book and Page: Doc. RECORDING COVER SHEET Title of Document: Date of Document: Grantors: Grantee(s): Mailing Address(es): Legal Description: See Exhibit A Reference Book and Page: Doc. # Book at Page DEED OF TRUST THIS DEED,

More information

FORM 151 AGREEMENT FOR PRIME BROKERAGE CLEARANCE SERVICES

FORM 151 AGREEMENT FOR PRIME BROKERAGE CLEARANCE SERVICES FORM 151 AGREEMENT FOR PRIME BROKERAGE CLEARANCE SERVICES This Agreement sets forth the terms and conditions under which Bolton Global Capital, Inc., its successors and assigns (the "Executing Broker")

More information

Thank you for your interest in becoming a customer of Southern Glazer's Wine & Spirits of Nevada

Thank you for your interest in becoming a customer of Southern Glazer's Wine & Spirits of Nevada New Account Forms Thank you for your interest in becoming a customer of Southern Glazer's Wine & Spirits of Nevada Please download, complete and submit the following forms to: New Account Credit Agent

More information

Instructions for Completing the Customs Power of Attorney

Instructions for Completing the Customs Power of Attorney Instructions for Completing the Customs Power of Attorney 1. Check the box that describes the status of your business. Foreign Company - Check the "Corporation" box. 2. Enter your Federal Tax ID number

More information

INTERNATIONAL WIRE GROUP INC

INTERNATIONAL WIRE GROUP INC INTERNATIONAL WIRE GROUP INC FORM 8-K (Current report filing) Filed 10/26/07 for the Period Ending 10/26/07 Address 12 MASONIC AVENUE CAMDEN, NY 13316 Telephone 314 416-8216 CIK 0000947429 Symbol ITWG

More information

Deed of Trust. a resident of the Commonwealth of Virginia, whose full residence or business address is

Deed of Trust. a resident of the Commonwealth of Virginia, whose full residence or business address is "THIS DEED OF TRUST SHALL NOT, WITHOUT THE CONSENT OF THE SECURED PARTY HEREUNDER, BE SUBORDINATED UPON THE REFINANCING OF ANY PRIOR MORTGAGE." Return To: Tax Map Reference #: RPC/Parcel ID #: Prepared

More information

Personal Property Security Agreement

Personal Property Security Agreement Personal Property Security Agreement (This form is intended for use in Washington State consumer transactions and for related personal property specified in Exhibit A; it is not intended for general use

More information

«f80» «f81» «f82», «f83» LENDER SERVICING AGREEMENT

«f80» «f81» «f82», «f83» LENDER SERVICING AGREEMENT .. The fields in this document are filled in by Mortgage+Care Loan Origination Software. Please contact us at (800)481-2708 or www.mortcare.com for a list of mergeable documents. «f80» «f81» «f82», «f83»

More information

Grantor(s) Initials Page 1 of 5 Trustee(s) Initials

Grantor(s) Initials Page 1 of 5 Trustee(s) Initials CERTIFICATION OF TRUST TO BE COMPLETED BY TRUSTEE The undersigned, constituting all of the currently acting trustees of the ( Trust ), being first duly sworn, depose and say: 1. DATE TRUST CREATED 2. EXISTENCE

More information

Private Party Purchase Cover Sheet

Private Party Purchase Cover Sheet Private Party Purchase Cover Sheet To: Lending Operations From: FARM BUREAU AGENT E-mail: LendingFax@farmbureaubank.com Contact Number: ( ) - Fax: 800.499.4950 Email: farmbureau@agent.com Date: Total Number

More information

Discount Window Lending Agreement Instructions

Discount Window Lending Agreement Instructions Federal Reserve Bank of Atlanta Discount Window Lending Agreement Instructions Operating Circular 10 Federal Reserve Bank of Atlanta Discount Window Lending Agreement Instructions 2 Table of Contents Discount

More information

WHOLESALE BROKER AGREEMENT. THIS WHOLESALE BROKER AGREEMENT (this Agreement ) dated as of the

WHOLESALE BROKER AGREEMENT. THIS WHOLESALE BROKER AGREEMENT (this Agreement ) dated as of the WHOLESALE BROKER AGREEMENT THIS WHOLESALE BROKER AGREEMENT (this Agreement ) dated as of the day of,, by and among the entities indicated on Schedule A attached hereto and incorporated herein by reference

More information

CUSTOMER CREDIT APPLICATION FOR TRADE ACCOUNT CORP-FIN-CON-005 Standard Credit Terms and Application Form

CUSTOMER CREDIT APPLICATION FOR TRADE ACCOUNT CORP-FIN-CON-005 Standard Credit Terms and Application Form CUSTOMER CREDIT APPLICATION FOR TRADE ACCOUNT CORP-FIN-CON-005 Standard Credit Terms and Application Form Section 1 Applicant details Name (Company name / Partnership/Sole Trader) Trust Name (if a Trust)

More information

ATLANTIC CONCRETE PRODUCTS, INC.

ATLANTIC CONCRETE PRODUCTS, INC. P.O. Box 129 Tullytown, PA 19007-0098 Tel.(215) 945-5600 Fax (215) 945-5016 CREDIT APPLICATION DATE: TOTAL PAGES: 1 of 5 TO: FROM: Steve Schlussel Accts Receivable Mgr COMPANY: COMPANY: Atlantic Concrete

More information

Capitol-Husting Company, Inc. /Allstate Liquor & Wine Co.

Capitol-Husting Company, Inc. /Allstate Liquor & Wine Co. Capitol-Husting Company, Inc. /Allstate Liquor & Wine Co. Wholesalers Importers of Liquor and Wine CAPITOL-HUSTING COMPANY INC. ALLSTATE LIQUOR & WINE CO., INC. 12001 WEST CARMEN AVENUE 12005 WEST CARMEN

More information

* Corporation General Partnership Limited Partnership LLC Sole Proprietorship Non Profit Other Accounts Payable: Name

* Corporation General Partnership Limited Partnership LLC Sole Proprietorship Non Profit Other Accounts Payable: Name INVACARE CORPORATION New Customer Change of Ownership Customer Credit Application *Legal Name of Business Trade Name (DBA) *Billing Address: Shipping Address (if different): *Federal Tax ID # * # of Years

More information

BROKER REGISTRATION AGREEMENT

BROKER REGISTRATION AGREEMENT BROKER REGISTRATION AGREEMENT THIS BROKER REGISTRATION AGREEMENT (this Agreement ) is made and entered into as of the day of, of 20, (the Effective Date ) by and between (the Broker ) and RCN Capital,

More information

New York Public Employee Retirement System Special Durable Power of Attorney (Rev. 6/18)

New York Public Employee Retirement System Special Durable Power of Attorney (Rev. 6/18) Office of the New York State Comptroller 110 State Street, Albany, New York 12244-0001 Received New York Public Employee Retirement System Special Durable Power of Attorney (Rev. 6/18) This is a Public

More information

GUARANTY (Individual Guarantor - Michael B. Alexander) WHEREAS, ECHO BRIDGE ENTERTAINMENT, LLC, a Delaware limited liability

GUARANTY (Individual Guarantor - Michael B. Alexander) WHEREAS, ECHO BRIDGE ENTERTAINMENT, LLC, a Delaware limited liability 14 The indebtedness evidenced by this instrument is subordinated to the prior payment in full of the Senior Indebtedness (as defined in the Intercreditor and Subordination Agreement hereinafter referred

More information