Information Regarding / Información acerca de Unlicensed Money Transmitter / Your Personal Information /

Size: px
Start display at page:

Download "Information Regarding / Información acerca de Unlicensed Money Transmitter / Your Personal Information /"

Transcription

1 STATE OF CALIFORNIA BUSINESS, TRANSPORTATION AND HOUSING AGENCY DEPARTMENT OF FINANCIAL INSTITUTIONS WILLIAM S. HARAF, Commissioner of Financial Institutions COMPLAINT REGARDING AN UNLICENSED MONEY TRANSMITTER / QUEJA CON RESPECTO A UN TRANSMISOR DE DINERO NO AUTHORIZADO Information Regarding / Información acerca de Unlicensed Money Transmitter / Your Personal Information / Transmisor de Dinero Sin Licencia Su Información Personal Name and Office Address / Your Name and Address / Nombre y Dirección de la Oficina Su Nombre y Dirección Telephone / Teléfono Your Address / Su Dirección de Correo Electrónico Contact Person / Persona de Contacto Your Telephone / Su Teléfono Your Fax Number / Su Número de Fax Your Employer / So Empleador How and when did you become aware of this money transmitter? Describe everything you personally observed about the conduct of its money transmission business. Submit copies of the following documents with this form: receipts, advertisements, photographs of money transmitter office(s), and brochures that show the person or company complained of are engaged in the business of money transmission. Cómo y cuándo usted se enteró de este transmisor de dinero? Describe todo lo que personalmente observó sobre la conducta de su negocio de envío de dinero. Envíe copias de los siguientes documentos con esta forma: recibos publicidad, fotografías de transmisor de dinero, y folletos que muestran la persona o la empresa denunciada está dedicado al negocio de transmisión de dinero. 45 Fremont Street, Suite 1700 San Francisco, CA (415) th Street Sacramento, CA (916) S. Spring Street, Suite Los Angeles, CA (213) Metropolitan Drive, Suite 108 San Diego, CA (619)

2 COMPLAINT REGARDING AN UNLICENSED MONEY TRANSMITTER / QUEJA CON RESPECTO A UN TRANSMISOR DE DINERO NO AUTHORIZADO Page / Pagina 2 Are you willing to appear in court to testify to the foregoing? Yes / Sí No / No Está usted dispuesto a comparecer ante el tribunal para dar testimonio de lo anterior? Your Signature / Su Firma Date / Fecha Please complete and mail or fax this form and related documents to the address below. Form 2120 (Rev ) Julio Prada Department of Financial Institutions 45 Fremont Street, Suite 1700 San Francisco, CA jprada@dfi.ca.gov Fax #: (415)

3 11/2/11 USD: : Campus Cash Home Campus Cash Campus Cash What is CampusCash? CampusCash is the key to all your purchases and campus services at USD. It is a prepaid declining balance account managed through your USD ID card (Campus Card). To activate your account, all you need to do is make a deposit in any amount you choose. Within minutes you can use your ID everywhere CampusCash is accepted. Purchases are deducted from your account, and your remaining balance is instantly displayed. CampusCash is the safest, fastest, and easiest way to obtain the things you need. Advantages of CampusCash: CampusCash gives you flexibility and is convenient to use. Save time: CampusCash is faster than checks or cash - just use your card for payment and before you know it, you're on your way. CampusCash value additions are easy to make and are available within minutes. Anyone can add value to your account, but only you, with your ID, can make purchases. Your balance carries forward as long as you have a valid ID. If you accidentally lose your ID, your funds are secure and immediately available when you receive a replacement card. There are no membership fees, service charges, or minimum balances or "buy-in" required. Where you may use CampusCash: On-Campus USD Bookstore Campus Dining /Vending La Gran Terraza Copley Library Legal Research Center Copy & Graphic Mail Center Computer Labs Jenny Craig Pavilion UC Ticket Booth Outdoor Adventures Campus Rec Sport s Center Snack Bar Health Center Off-Campus Ryan s Café (619) Linda Vista Road Olive Café (858) Santa Clara Place Mission Beach Domino s Pizza (619) Linda Vista Road How to purchase CampusCash: 1/2

4 11/2/11 USD: : Campus Cash You may make deposits right here on our secure web site. Go to and log in to make a deposit. Use one of the Card Systems Value Terminal (CSVT) located in the Copley Library, Serra 205 Computer Lab, Olin 122 Computer Lab, or the Hahn University Center to apply value to your USD ID with cash. Stop by the Office located in the UC, room 127 and add value to your USD ID with cash, check, or credit card. We accept Visa, MasterCard, American Express, and Discover. Fax your request into our office using the CampusCash Enrollment Form. Fax: (619) Terms and Conditions: The participant understands and agrees that: CampusCash accounts are not transferable. No interest or other earnings will be paid to the holder or credited by USD. Restitution is required for overdrafts resulting from off-line transactions. USD is not responsible for any lost or stolen cards. Replacement cards are $18.00 Patrons may not make cash withdrawals from their CampusCash accounts. Funds may only be refunded upon graduation or by formally withdrawing from the university. CampusCash will expire 90 days after your graduation, or withdrawal, date. If you have a balance in your account you will need to go to the Campus Card office to request a refund within this time frame. The user is responsible for immediately reporting lost or stolen cards in person to the Office. The university is not responsible for the use of any lost or stolen card until reported. Current account statements are available online at our CampusCash site, All sales transactions are debited from the CampusCash account and the user is responsible for observing the transaction debited at the point and time of sale and for the monitoring of his/her own account balance. CampusCash accounts, transcripts of their use, forms and records are property of the university. Use of these accounts may be revoked at any time. Terms and conditions are subject to revisions, additions or deletions without notice at any time. 2/2

5 11/2/11 CampusCash Online 5998 Alcala Park University Center, Room 127 San Diego, CA (619) Phone (619) Fax M-F: 9:00 am to 4:00 pm Information What is CampusCash? HELP Login MySanDiego Users Parents and Guest Users CampusCash Online Welcome to the CampusCash account management web site! Please select one of the login links to the left to enter the site. If you are not a student or employee of the University of San Diego, you will need to be granted guest access by a USD affiliated individual before you can make deposits to their account. Once they register you as a guest, an will be sent to your account with an individualized login and password. Need Help? News Sep 16, 2009: Saved Credit Card Profile Alert Sep 03, 2009: System Maintenance Aug 27, 2009: Maintenance - Service unavailable 5PM Aug 12, 2009: System Maintenance - Update Aug 12, 2009: System Maintenance Jul 01, 2009: American Express Service Change USD Home --U.S. Patent No. 6,963,857 campuscash.sandiego.edu 1/1

Information Regarding / Información acerca de Unlicensed Money Transmitter / Your Personal Information /

Information Regarding / Información acerca de Unlicensed Money Transmitter / Your Personal Information / STATE OF CALIFORNIA BUSINESS, TRANSPORTATION AND HOUSING AGENCY DEPARTMENT OF FINANCIAL INSTITUTIONS WILLIAM S. HARAF, Commissioner of Financial Institutions www.dfi.ca.gov COMPLAINT REGARDING AN UNLICENSED

More information

Information Regarding / Información acerca de Unlicensed Money Transmitter / Your Personal Information /

Information Regarding / Información acerca de Unlicensed Money Transmitter / Your Personal Information / STATE OF CALIFORNIA BUSINESS, TRANSPORTATION AND HOUSING AGENCY DEPARTMENT OF FINANCIAL INSTITUTIONS WILLIAM S. HARAF, Commissioner of Financial Institutions www.dfi.ca.gov COMPLAINT REGARDING AN UNLICENSED

More information

Information Regarding / Información acerca de Unlicensed Money Transmitter / Your Personal Information /

Information Regarding / Información acerca de Unlicensed Money Transmitter / Your Personal Information / STATE OF CALIFORNIA BUSINESS, TRANSPORTATION AND HOUSING AGENCY DEPARTMENT OF FINANCIAL INSTITUTIONS WILLIAM S. HARAF, Commissioner of Financial Institutions www.dfi.ca.gov COMPLAINT REGARDING AN UNLICENSED

More information

Information Regarding / Información acerca de Unlicensed Money Transmitter / Your Personal Information /

Information Regarding / Información acerca de Unlicensed Money Transmitter / Your Personal Information / STATE OF CALIFORNIA BUSINESS, TRANSPORTATION AND HOUSING AGENCY DEPARTMENT OF FINANCIAL INSTITUTIONS WILLIAM S. HARAF, Commissioner of Financial Institutions www.dfi.ca.gov COMPLAINT REGARDING AN UNLICENSED

More information

OFFICE OF COMMON INTEREST COMMUNITY OMBUDSMAN CIC#: DEPARTMENT OF JUSTICE

OFFICE OF COMMON INTEREST COMMUNITY OMBUDSMAN CIC#: DEPARTMENT OF JUSTICE RETURN THIS FORM TO: FOR OFFICIAL USE: (Devuelva Este Formulario a): (Para Uso Oficial) OFFICE OF COMMON INTEREST COMMUNITY OMBUDSMAN CIC#: DEPARTMENT OF JUSTICE (Caso No) STATE OF DELAWARE Investigator:

More information

Benedictine College Financial Aid

Benedictine College Financial Aid 2015 2016 Institutional Verification Document V4 Dependent Your 2015 2016 Free Application for Federal Student Aid (FAFSA) was selected for review in a process called verification. The law says that before

More information

Gold Card Policies and Procedures

Gold Card Policies and Procedures Gold Card Policies and Procedures Use of the ABAC Gold Card The cardholder agrees that the ABAC Gold Card is the property of Abraham Baldwin Agricultural College and can be confiscated from bearer as a

More information

To be considered for vendor space and be added to our database, please send all of the following:

To be considered for vendor space and be added to our database, please send all of the following: VENDOR INFORMATION Latin Food & Music Festival 2014 date: Saturday, September 27 To be considered for vendor space and be added to our database, please send all of the following: Information about your

More information

New words to remember

New words to remember Finanza Toolbox Materials When you open a checking account you put money in the bank. Then you buy a book of checks from the bank. Using checks keeps you from having to carry cash with you. You can use

More information

Para ser considerado para obtener un espacio para vender y ser incluido a nuestro sistema de datos, por favor envíenos la siguiente información:

Para ser considerado para obtener un espacio para vender y ser incluido a nuestro sistema de datos, por favor envíenos la siguiente información: Vendor Information Latin Food & Music Family Festival: Saturday, October 3, 2015 To be considered for vendor space and be added to our database, please send all of the following: Information about your

More information

BROWARD METROPOLITAN PLANNING ORGANIZATION TITLE VI DISCRIMINATION COMPLAINT PROCEDURES

BROWARD METROPOLITAN PLANNING ORGANIZATION TITLE VI DISCRIMINATION COMPLAINT PROCEDURES BROWARD METROPOLITAN PLANNING ORGANIZATION TITLE VI DISCRIMINATION COMPLAINT PROCEDURES The Broward Metropolitan Planning Organization (Broward MPO) values diversity and both welcomes and actively seeks

More information

SUBCHAPTER A. AUTOMOBILE INSURANCE DIVISION 3. MISCELLANEOUS INTERPRETATIONS 28 TAC 5.204

SUBCHAPTER A. AUTOMOBILE INSURANCE DIVISION 3. MISCELLANEOUS INTERPRETATIONS 28 TAC 5.204 Part I. Texas Department of Insurance Page 1 of 10 SUBCHAPTER A. AUTOMOBILE INSURANCE DIVISION 3. MISCELLANEOUS INTERPRETATIONS 28 TAC 5.204 1. INTRODUCTION. The commissioner of insurance adopts amendments

More information

Quest, Inc. Title VI Complaint Procedures and Forms

Quest, Inc. Title VI Complaint Procedures and Forms Quest, Inc. Title VI Complaint Procedures and Forms 1.0 Title VI Procedures and Compliance FTA Circular 4702.1B, Chapter III, Paragraph 6: All recipients shall develop procedures for investigating and

More information

WSFCCA MEMBERSHIP and ACCIDENTAL/MEDICAL APPLICATION 2013-2014

WSFCCA MEMBERSHIP and ACCIDENTAL/MEDICAL APPLICATION 2013-2014 WSFCCA MEMBERSHIP and ACCIDENTAL/MEDICAL APPLICATION 2013-2014 Christine Price, President 425-774- 9439 Lorri Hope, Treasurer & Membership 509-627- 1692 Email: wsfcca@aol.com www.wsfcca.com Washington

More information

Venezuela Business visa Application

Venezuela Business visa Application Venezuela Business visa Application IMPORTANT: Please enter your contact information Name: Email: Tel: Mobile: The latest date you need your passport returned in time for your travel: Venezuela business

More information

Venezuela Official visa Application

Venezuela Official visa Application Venezuela Official visa Application Please enter your contact information Name: Email: Tel: Mobile: The latest date you need your passport returned in time for your travel: Venezuela official visa checklist

More information

Monterey County Behavioral Health Policy and Procedure

Monterey County Behavioral Health Policy and Procedure Monterey County Behavioral Health Policy and Procedure 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Policy Number 144 Policy Title Disclosure of Unlicensed Status for License

More information

US Bank Campus Card FAQ

US Bank Campus Card FAQ US Bank Campus Card FAQ Is there a limit to a cash advance? You may receive a cash advance up to the balance on your card, however Financial Institutions may impose a limit on how much money you can receive.

More information

SUBCHAPTER A. AUTOMOBILE INSURANCE DIVISION 3. MISCELLANEOUS INTERPRETATIONS 28 TAC 5.204

SUBCHAPTER A. AUTOMOBILE INSURANCE DIVISION 3. MISCELLANEOUS INTERPRETATIONS 28 TAC 5.204 Part I. Texas Department of Insurance Page 1 of 11 SUBCHAPTER A. AUTOMOBILE INSURANCE DIVISION 3. MISCELLANEOUS INTERPRETATIONS 28 TAC 5.204 1. INTRODUCTION. The Texas Department of Insurance proposes

More information

PATIENT'S INFORMATION REGISTRATION SHEET / INFORMACION DEL PACIENTE

PATIENT'S INFORMATION REGISTRATION SHEET / INFORMACION DEL PACIENTE DAN S. COHEN, M.D PATIENT'S INFORMATION REGISTRATION SHEET / INFORMACION DEL PACIENTE PLEASE PRINT CLEARLY / POR FAVOR ESCRIBA LEGIBLEMENTE TODAY S DATE / FECHA DE HOY: PATIENT'S NAME/NOMBRE DEL PACIENTE:

More information

Customer Name Address City, State Zip <INSERT DATE>

Customer Name Address City, State Zip <INSERT DATE> Customer Name Address City, State Zip Announcement to Customers: The transition is complete Dear < insert name>, has successfully completed transitioning your water utility account. Once

More information

MIT TechCASH Virtual Chat with John McDonald, MIT TechCASH Monday, August 19, 2013 12:30 p.m. 1:30 p.m. (EST)

MIT TechCASH Virtual Chat with John McDonald, MIT TechCASH Monday, August 19, 2013 12:30 p.m. 1:30 p.m. (EST) MIT TechCASH Virtual Chat with John McDonald, MIT TechCASH Monday, August 19, 2013 12:30 p.m. 1:30 p.m. (EST) TechCASH website: http://studentlife.mit.edu/techcash (Q) Is there a card for TechCASH or is

More information

How To Get A Venezuela Business Visa

How To Get A Venezuela Business Visa Venezuela Business visa Application Please enter your contact information Name: Email: Tel: Mobile: The latest date you need your passport returned in time for your travel: Venezuela business visa checklist

More information

John Burroughs Agcy 14515 Briarhills#216 Houston TX 77077

John Burroughs Agcy 14515 Briarhills#216 Houston TX 77077 John Burroughs Agcy 14515 Briarhills#216 Houston TX 77077 Verify the vehicles and drivers listed on the Policy Declarations. Check the vehicle identification number (VIN) listed on these documents; its

More information

PAYROLL CARD FREQUENTLY ASKED QUESTIONS

PAYROLL CARD FREQUENTLY ASKED QUESTIONS The following document provides answers to frequently asked questions regarding the Umpqua Bank Payroll Card. Contact Customer Care at 800-650-7141 with questions. Card Basics Q. How does the Payroll Card

More information

Fort Bend Independent School District Summer School Course Online Course Request and Payment Guide

Fort Bend Independent School District Summer School Course Online Course Request and Payment Guide This year you can make your course selections for 2014 Summer School Programs in Skyward Family Access. Skyward Family Access allows you to select your summer school course and pay for it online via a

More information

Ecuador Official visa Application

Ecuador Official visa Application Ecuador Official visa Application Please enter your contact information Name: Email: Tel: Mobile: The latest date you need your passport returned in time for your travel: Ecuador official visa checklist

More information

New words to remember

New words to remember Finanza Toolbox Materials Checking Accounts When you open a checking account you put money in the bank. Then you buy a book of checks from the bank. Using checks keeps you from having to carry cash with

More information

Forever Direct Deposit

Forever Direct Deposit Forever Direct Deposit In order to expedite the delivery of profits and bonuses to Distributors registered in the USA, we offer a direct deposit service. Forever Direct Deposit is available to any Distributor

More information

The Webster Visa Prepaid Debit Card Frequently Asked Questions

The Webster Visa Prepaid Debit Card Frequently Asked Questions Contact Us Welcome to Webster Bank. Please contact our Card Services support line at 866.242.0861 with any questions or concerns, 24/7. Thank you for being a valued Webster Customer! The Webster Visa Prepaid

More information

YOUR EMPLOYEE BENEFIT PLAN

YOUR EMPLOYEE BENEFIT PLAN YOUR EMPLOYEE BENEFIT PLAN Retirement Life Insurance Program Catholic Diocese of Cleveland 1404 East Ninth Street, 8 th Floor Cleveland, OH 44114-2570 (216) 696-6525 TO OUR RETIRED EMPLOYEES: All of us

More information

DirectNET Consumer Online Banking

DirectNET Consumer Online Banking DirectNET Consumer Online Banking SM Last Amended 07/2014 This document sets forth the terms and conditions (the Agreement ) for the DirectNET Consumer Online Banking Service ( Service ) offered by California

More information

UMBRELLA POLICY PACKET. RACHEL J LAWRENCE November 25, 2011 7701 WURZBACH RD APT 1701 SAN ANTONIO TX 78229-4432. Important Messages

UMBRELLA POLICY PACKET. RACHEL J LAWRENCE November 25, 2011 7701 WURZBACH RD APT 1701 SAN ANTONIO TX 78229-4432. Important Messages JUM1392 00000 DM00000 UMBRELLA POLICY PACKET RACHEL J LAWRENCE November 25, 2011 7701 WURZBACH RD APT 1701 SAN ANTONIO TX 78229-4432 Effective: 01/01/2012 to 01/01/2013 GAR 01085 52 74 71U Important Messages

More information

FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner

FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures and Training Lisa C. Fitzpatrick, Assistant Deputy Commissioner

More information

Received by NSD/FARA Registration Unit 06/25/2012 3:30:37 PM

Received by NSD/FARA Registration Unit 06/25/2012 3:30:37 PM Received by NSD/FARA Registration Unit 06/25/2012 3:30:37 PM OMB NO. 1124-0006; Expires February 28, 2014 Exhibit A to Registration Statement Pursuant to the Foreign Agents Registration Act of 1938, as

More information

Sponsorship Package * Paquete de Patrocinios

Sponsorship Package * Paquete de Patrocinios Sponsorship Package * Paquete de Patrocinios Saturday September 19, 2015 From 9:00 AM to 5:00 PM Dear Community Partner, Homies Unidos Inc. is excited to begin planning for our first Central American Youth

More information

CA Dream Application References

CA Dream Application References CA Dream Application References 2014 California High School Counselor Workshop Guide Page 171 California Nonresident Tuition Exemption For Eligible California High School Graduates (The law passed by

More information

General. Q. Where do I send a pay-off? A. Payoffs can be given to a Member Service Representative at the branch or mailed to:

General. Q. Where do I send a pay-off? A. Payoffs can be given to a Member Service Representative at the branch or mailed to: General Q. What is a credit union? A. A credit union is a not-for-profit organization that is owned by its members. The primary function of the credit union is to serve its members. Credit unions focus

More information

FORMULARIO DE INSCRIPCIÓN

FORMULARIO DE INSCRIPCIÓN INFORMACIÓN PERSONAL PERSONAL DATA APELLIDOS / SURNAME MBRE / NAME FECHA DE NACIMIENTO (D/M/A) / BIRTHDATE (D/M/Y) NACIONALIDAD / CITIZENSHIP NÚMERO DE PASAPORTE / PASSPORT NUMBER HOMBRE / MALE MUJER /

More information

The EZpay Online Payment Program

The EZpay Online Payment Program The EZpay Online Payment Program Registering With EZpay To begin using the program, click on the EZpay link provided by your school district. Your registration is tracked by email address so if parents

More information

PERSONAL INFORMATION / INFORMACIÓN GENERAL Last Name / Apellido Middle Name / Segundo Nombre Name / Nombre

PERSONAL INFORMATION / INFORMACIÓN GENERAL Last Name / Apellido Middle Name / Segundo Nombre Name / Nombre COMPUTER CLASS REGISTRATION FORM (Please Print Clearly Lea con cuidado) To register for the Computer Technology Program, please complete the following form. All fields in this form must be filled out in

More information

THE FOUR AMBASSADORS ASSOCIATION, INC.

THE FOUR AMBASSADORS ASSOCIATION, INC. THE FOUR AMBASSADORS ASSOCIATION, INC. INSTRUCTIONS 1. Please complete the application in full. Be sure to fill in your name exactly as it should appear on the approval form. In order to expedite the approval

More information

Otra información Importante / Other relevant information Como conoció el programa / How did you learn about the programme

Otra información Importante / Other relevant information Como conoció el programa / How did you learn about the programme COMPLETAR EL SIGUIENTE FORMULARIO Y MANDARLO A / COMPLETE THE FOLLOWING FORM AND SEND IT TO: EMAIL: study.abroad@uab.es FAX. +34 93 433 50 26 POST: Fundació UAB (Àrea Internacional) Sant Antoni Maria Claret,

More information

105-01 Compliance with the National Voter Registration Act of 1993

105-01 Compliance with the National Voter Registration Act of 1993 Connecticut WIC Program Manual Federal Fiscal Year 2016 Section: Voter Registration 105-01 Compliance with the National Voter Registration Act of 1993 Connecticut WIC Program Manual WIC 105-01 SECTION:

More information

Tourist Visa Application Form

Tourist Visa Application Form Introduction Tourist Visa Application Form This document contains the official visa application form issued by the Immigration and Naturalization Services of Costa Rica (Direccion General de Migracion)

More information

PATIENT INFORMATION. Today s Date. I do not currently carry insurance (initial) Patient s Last Name: Patient s First Name: MEDICAL INSURANCE

PATIENT INFORMATION. Today s Date. I do not currently carry insurance (initial) Patient s Last Name: Patient s First Name: MEDICAL INSURANCE PATIENT INFORMATION Please present a Photo ID and ALL insurance cards to receptionist. If items are not presented, full payment will be due at time of service. Please know ALL Co-Pays are due at time of

More information

Financial Services (OFS) Parent s ROAD Session

Financial Services (OFS) Parent s ROAD Session Financial Services (OFS) Parent s ROAD Session 1 Agenda Which Office? financialservices.luther.edu Payment Due Dates Monthly payment plans Work Credit Plans Checking Accounts for Students Other Parent

More information

First Federal Bank Online Banking Terms and Conditions Agreement Online Banking Service Business Online Banking Service Bill Payment Mobile Banking

First Federal Bank Online Banking Terms and Conditions Agreement Online Banking Service Business Online Banking Service Bill Payment Mobile Banking First Federal Bank Online Banking Terms and Conditions Agreement Online Banking Service Business Online Banking Service Bill Payment Mobile Banking First Federal Bank s Online Banking is available to all

More information

DEPARTMENT OF BUSINESS OVERSIGHT Ensuring a Fair and Secure Financial Services Marketplace for all Californians

DEPARTMENT OF BUSINESS OVERSIGHT Ensuring a Fair and Secure Financial Services Marketplace for all Californians STATE OF CALIFORNIA BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY DEPARTMENT OF BUSINESS OVERSIGHT Ensuring a Fair and Secure Financial Services Marketplace for all Californians EDMUND G. BROWN JR., Governor

More information

ONLINE BANKING APLICATION

ONLINE BANKING APLICATION ONLINE BANKING APLICATION Taken by: Initials CUSTOMER INFORMATION Extension Name: New User Existing User Modification Address: TIN/SSN: City: State: Zip: Home Phone: Work Phone: Account Name List all the

More information

Prepaid Debit Card FAQs (FAQs with an asterisk appear in the prepaid cardholder collateral piece.)

Prepaid Debit Card FAQs (FAQs with an asterisk appear in the prepaid cardholder collateral piece.) Prepaid Debit Card FAQs (FAQs with an asterisk appear in the prepaid cardholder collateral piece.) Has Bellco partnered with a prepaid debit card vendor? Yes. Bellco has partnered with The Members Group

More information

Save the Date! May 17-18, 2015. (Holiday Inn Austin Midtown) 6000 Middle Fiskville Road Austin, TX 78752

Save the Date! May 17-18, 2015. (Holiday Inn Austin Midtown) 6000 Middle Fiskville Road Austin, TX 78752 Save the Date! May 17-18, 2015 (Holiday Inn Austin Midtown) 6000 Middle Fiskville Road Austin, TX 78752 Promotores/CHW/Instructor Registration Fee: $35.00* Includes conference materials, CEUs, and meals

More information

Baylor University Policy No. 24220

Baylor University Policy No. 24220 Baylor University Policy No. 24220 Certificate for Baylor University Supplementary Contract providing Dependents Group Life Insurance Benefits This certificate becomes a part of, and should be attached

More information

Action Required: Take note and confirm participation before 15 May 2015

Action Required: Take note and confirm participation before 15 May 2015 When replying please quote: Ref.: NT-NT4-4.47 EMX356 13 April 2015 To: States, Territories and International Organizations Subject: Workshop on Air Traffic Flow Management (ATFM) Implementation for the

More information

"You" and "your" mean the account holder(s) and anyone else with authority to deposit, withdraw, or exercise control over the funds in the account.

You and your mean the account holder(s) and anyone else with authority to deposit, withdraw, or exercise control over the funds in the account. FIRST BANK KANSAS Information about Electronic Fund Transfers The Electronic Fund Transfer Act and Regulation E require banks to provide certain information to customers regarding electronic fund transfer

More information

University of California Briefing Notes for 2014/15 Applicants

University of California Briefing Notes for 2014/15 Applicants University of California Briefing Notes for 2014/15 Applicants General Concepts 1. UCEAP (University of California Education Abroad Program) Website: http://eap.ucop.edu/reciprocalexchanges/pages/undergraduates/applyundergraduates.aspx

More information

PATIENT INFORMATION. Patient Name/Nombre

PATIENT INFORMATION. Patient Name/Nombre Patient Information Cont d PATIENT INFORMATION Patient Name/Nombre Birth date/fecha de Nacimeinto Age/Edad Sex/Sexo How do you prefer to be addressed by our physicians and staff? Como prefiere que le llamen

More information

I don t know my Employee Identification Number. How do I get it? Contact LAUSD Personnel, Human Resources, or your Supervisor.

I don t know my Employee Identification Number. How do I get it? Contact LAUSD Personnel, Human Resources, or your Supervisor. FAQ What is California Credit Union s Pay Card? CCU s Pay Card is a Visa -branded reusable debit card created exclusively for LAUSD employees. The employee has access to their pay 24 hours a day, 7 days

More information

Installing the Pharos Client onto your Macintosh laptop

Installing the Pharos Client onto your Macintosh laptop Downloading Pharos Wi-Fi installers for Windows and Macintosh Computers The remote print system can be installed on either a PC or a Macintosh computer. Installing the Pharos Client onto your Macintosh

More information

Medicare Part D Creditable Coverage Notice Open Enrollment Active Carpenters

Medicare Part D Creditable Coverage Notice Open Enrollment Active Carpenters Medicare Part D Creditable Coverage Notice Open Enrollment Active Carpenters Important Notice from Southwest Carpenters Health and Welfare Trust about Prescription Drug Coverage for People with Medicare

More information

Patient Information NAME SOCIAL SECURITY # (NOMBRE) LAST/APELLIDO FIRST/PRIMER INITIAL (SEGURO SOCIAL)

Patient Information NAME SOCIAL SECURITY # (NOMBRE) LAST/APELLIDO FIRST/PRIMER INITIAL (SEGURO SOCIAL) 7887 North Kendall Drive Suite 210 Miami, Florida 33156 305.598.1555 office 305.598.1155 fax www.vascularandspine.com Patient Information NAME SOCIAL SECURITY # (NOMBRE) LAST/APELLIDO FIRST/PRIMER INITIAL

More information

CITY OF LAREDO Application for Certification of Compliance for Utility Connection ($ 50.00 Application Fee Ordinance No.

CITY OF LAREDO Application for Certification of Compliance for Utility Connection ($ 50.00 Application Fee Ordinance No. CITY OF LAREDO Application for Certification of Compliance for Utility Connection ($ 50.00 Application Fee Ordinance No. 2012-O-158) Date of application: Applicant Address Telephone Cellular E-Mail Address

More information

LOS ANGELES UNIFIED SCHOOL DISTRICT Policy Bulletin

LOS ANGELES UNIFIED SCHOOL DISTRICT Policy Bulletin Policy Bulletin TITLE: NUMBER: ISSUER: Procedures for Requests for Educationally Related Records of Students with or Suspected of Having Disabilities DATE: February 9, 2015 Sharyn Howell, Executive Director

More information

Summer Employment Application 2014

Summer Employment Application 2014 Summer Employment Application 2014 Thank you for your interest in the North Shore Youth Career Center s Summer Youth Program 2014. The next step in the process is to complete this application and include

More information

FORT DEARBORN LIFE Insurance Company

FORT DEARBORN LIFE Insurance Company FORT DEARBORN LIFE Insurance Company (A stock life insurance company herein called "We", "Us", "Our") Chicago, Illinois Administrative Office: 2400 Lakeside Blvd. Richardson, TX 75082-7399 Policyholder:

More information

PRICING INFORMATION (As of September 30, 2015)

PRICING INFORMATION (As of September 30, 2015) Visa Platinum Credit Card PRICING INFORMATION (As of September 30, 2015) Interest Rates and Interest Charges Annual Percentage Rate (APR) for Purchases 15.00% APR for Cash Advances Paying Interest 16.00%

More information

BILL PAYMENT SERVICES AGREEMENT TERMS AND CONDITIONS

BILL PAYMENT SERVICES AGREEMENT TERMS AND CONDITIONS BILL PAYMENT SERVICES AGREEMENT TERMS AND CONDITIONS This Agreement is the contract which covers your and our rights and responsibilities concerning Bill Payment Services ( Bill Pay ) offered to you by

More information

2013 ASIS PUERTO RICO CHAPTER Inc. PRESENTS: 2013 SECURITY PROGRAM DESIGN 2-Day Program

2013 ASIS PUERTO RICO CHAPTER Inc. PRESENTS: 2013 SECURITY PROGRAM DESIGN 2-Day Program 2013 ASIS PUERTO RICO CHAPTER Inc. PRESENTS: 2013 SECURITY PROGRAM DESIGN 2-Day Program WHERE: CENTRO EUROPA-Banco Popular de PR TRAINING CENTER (Frente Centro Bellas Artes, Ave Ponce De León, Santurce

More information

Colquitt County Schools Enrollment Packet. Request Forms Middle School

Colquitt County Schools Enrollment Packet. Request Forms Middle School Enrollment Packet Request Forms Middle School Statement of Objection to Use of Social Security Number for Student Identification Request I do not wish to provide the Social Security Number of my child/children.

More information

Nicholas C. Lambrou, M.D., LLC 6200 Sunset Drive, STE 502, Miami, Florida 33143 4306 Alton Road, 3 rd Floor, Miami Beach, Florida 33140

Nicholas C. Lambrou, M.D., LLC 6200 Sunset Drive, STE 502, Miami, Florida 33143 4306 Alton Road, 3 rd Floor, Miami Beach, Florida 33140 DATE: Fecha: DRIVER'S LICENSE# Numero De Licencia De Conducir: PATIENT NAME: BIRTH DATE: Nombre del paciente Fecha de nacimiento HOME ADDRESS: SOCIAL SECURITY: Direccion del hogar: Seguro Social CITY/STATE/ZIP:

More information

Lucas Graduate School of Business Executive-Style MBA Program

Lucas Graduate School of Business Executive-Style MBA Program Lucas Graduate School of Business Executive-Style MBA Program New Student Handbook Fall 2013 TABLE OF CONTENTS 01. MBA Worksheet....................................... 1 02. Coursework...........................................

More information

Enrollment Forms Packet (EFP)

Enrollment Forms Packet (EFP) Enrollment Forms Packet (EFP) Please review the information below. Based on your student(s) grade and applicable circumstances, you are required to submit documentation in order to complete this step in

More information

SUMMER PROGRAM APPLICATION

SUMMER PROGRAM APPLICATION www.iefl.org SUMMER PROGRAM APPLICATION LATINO STUDENT LEADERSHIP CONFERENCE July 29 August 3, 2012 ASTROCAMP IDYLLWILD, CALIFORNIA MAY BE DUPLICATED INLAND EMPIRE Dear Student: If you are an eighth- or

More information

Personal Account Switch Kit

Personal Account Switch Kit Personal Account Switch Kit Personal Account Switch Kit Switching banks is simple with our Account Switch Kit. The following forms are everything you need to get your new account with Vista Bank up and

More information

BALANCE DUE 10/25/2007 $500.00 STATEMENT DATE BALANCE DUE $500.00 PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT

BALANCE DUE 10/25/2007 $500.00 STATEMENT DATE BALANCE DUE $500.00 PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT R E M I T T O : IF PAYING BY MASTERCARD, DISCOVER, VISA, OR AMERICAN EXPRESS, FILL OUT BELOW: XYZ Orthopaedics STATEMENT DATE BALANCE DUE 10/25/2007 $500.00 BALANCE DUE $500.00 ACCOUNT NUMBER 1111122222

More information

Please note that the print size cannot be smaller than the text in the document.

Please note that the print size cannot be smaller than the text in the document. Clarification for Civil Rights Non-Discrimination Statement There have been several questions about using the short version of the USDA nondiscrimination statement on NSLP and SBP menus. It is acceptable

More information

Lucas Graduate School of Business Executive-Style MBA Program

Lucas Graduate School of Business Executive-Style MBA Program Lucas Graduate School of Business Executive-Style MBA Program New Student Handbook Spring 2013 Table of Contents 01. MBA Worksheet.................................. 1 02. Coursework......................................

More information

Your Invoice Payment Due Dates...3 Financial Responsibility...3 Payment Options... 3-5 Explanation of Charges... 5-6

Your Invoice Payment Due Dates...3 Financial Responsibility...3 Payment Options... 3-5 Explanation of Charges... 5-6 Table of Contents Your Invoice Payment Due Dates...3 Financial Responsibility...3 Payment Options... 3-5 Explanation of Charges... 5-6 Additional Information Payment Plan...7 Unpaid Balances...7 Credit

More information

WASHINGTON STATE EMPLOYEES CREDIT UNION ONLINE BANKING AGREEMENT

WASHINGTON STATE EMPLOYEES CREDIT UNION ONLINE BANKING AGREEMENT WASHINGTON STATE EMPLOYEES CREDIT UNION ONLINE BANKING AGREEMENT This Agreement is the contract which covers your and our rights and responsibilities concerning Online Banking services ("Online Banking")

More information

Lucas Graduate School of Business MBA-One Program

Lucas Graduate School of Business MBA-One Program Lucas Graduate School of Business MBA-One Program New Student Handbook Fall 2013 TABLE OF CONTENTS 01. MBA Worksheet....................................... 1 02. Coursework...........................................

More information

Online Banking Agreement

Online Banking Agreement Online Banking Agreement The Online Banking Agreement (Agreement) states the terms and conditions for OneWest Bank's Online Banking services. In this Agreement, "you", "your", and "yours" refer to the

More information

CHALLENGE TO INSTRUCTIONAL AND LIBRARY MATERIAL

CHALLENGE TO INSTRUCTIONAL AND LIBRARY MATERIAL CHALLENGE TO INSTRUCTIONAL AND LIBRARY MATERIAL The final decision for instructional and library materials rests with the School Board. The following procedures will be used for challenges to Instructional

More information

Insurance bill payment made easy

Insurance bill payment made easy Insurance bill payment made easy for our property & casualty customers Whether you have your personal insurance, business insurance, or (hopefully) both with Harleysville, we give you 4 convenient options

More information

DEKALB COUNTY TICKETS USER AGREEMENT SINGLE EVENT

DEKALB COUNTY TICKETS USER AGREEMENT SINGLE EVENT DEKALB COUNTY TICKETS USER AGREEMENT SINGLE EVENT This Agreement ( Agreement ) is entered into as of, ( Effective Date ) by and between ( User ), and Preservation of the Egyptian Theatre, Inc. ( DeKalb

More information

Frequently Asked Questions

Frequently Asked Questions Frequently Asked Questions Listed below are the answers to some of our most frequently asked questions. About Read to Succeed What is Read to Succeed? Read to Succeed is a free educational program sponsored

More information

queja: 1-800-955-7736 1-800-328-4090 1-800-252-3439 1-800-252-3439

queja: 1-800-955-7736 1-800-328-4090 1-800-252-3439 1-800-252-3439 IMPORTANT NOTICE To obtain information or make a complaint: AVISO IMPORTANTE Para obtener información o para someter una queja: You may call ReliaStar Life's toll-free telephone number for information

More information

Take Charge of Your Own Checking Account ASSESSMENT ONE: Assessment #1

Take Charge of Your Own Checking Account ASSESSMENT ONE: Assessment #1 Assessment #1 ASSESSMENT ONE: Knowledge ο T / F You can only deposit checks into a checking account. ο T / F When using a debit card to make a purchase, the money will immediately be be withdrawn from

More information

DAMAR MEDICAL CENTER, INC

DAMAR MEDICAL CENTER, INC PATIENT INFORMATION TODAY S DATE: / / (INFORMACION DEL PACIENTE) MES/DIA /AÑO: / / PATIENT S NAME: NOMBRE Y APELLIDO: D.O.B.: / / FECHA DE NACIMIENTO / / ADDRESS: CITY: ZIP CODE DIRECCION CIUDAD: CODIGO

More information

Online Bill Pay User Manual

Online Bill Pay User Manual \ Online Bill Pay User Manual Updated: November 14, 2014 Page 1 Table of Contents I. Welcome to Online Bill Pay... 3 II. New User Registration... 4 III. Login for Registered Users... 7 IV. Home Page Functionality...

More information

Congratulations on opening a

Congratulations on opening a Congratulations on opening a Health Savings Account! Let us help you manage your account easily, efficiently and securely. 05/2012 - CeB IMPORTANT! In order for us to comply with federal regulations, you

More information

WASHINGTON STATE EMPLOYEES CREDIT UNION ONLINE BANKING AGREEMENT BUSINESS ACCOUNTS

WASHINGTON STATE EMPLOYEES CREDIT UNION ONLINE BANKING AGREEMENT BUSINESS ACCOUNTS WASHINGTON STATE EMPLOYEES CREDIT UNION ONLINE BANKING AGREEMENT BUSINESS ACCOUNTS This Agreement is the contract which covers your and our rights and responsibilities concerning Online Banking services

More information

OFFER TO RENT. Procuring Broker: TENANT(s) above hereby offers to rent the above Property for a term of

OFFER TO RENT. Procuring Broker: TENANT(s) above hereby offers to rent the above Property for a term of Naples Marco Island Bonita Springs Estero OFFER TO RENT Property: Tenant(s): Agent: Procuring Broker: Date of offer: TENANT(s) above hereby offers to rent the above Property for a term of beginning on,

More information

The following State forms have been included in your claims kit packet:

The following State forms have been included in your claims kit packet: RE: Workers Compensation Claims Kit Dear Policyholder: Welcome to Tower Group Companies Workers Compensation Insurance Program. Although we hope that your company never experiences an injury to an employee,

More information

WELCOME TO. The exclusive, convenient and simple way to manage your Rodan + Fields earnings. Activate your RF Payday account directly from Pulse to:

WELCOME TO. The exclusive, convenient and simple way to manage your Rodan + Fields earnings. Activate your RF Payday account directly from Pulse to: WELCOME TO RF PAYDAY The exclusive, convenient and simple way to manage your Rodan + Fields earnings. Activate your RF Payday account directly from Pulse to: LOOK FOR YOUR VERY OWN COMPLIMENTARY BRANDED

More information

PWB Management Corporation 3092 Hull Avenue, Bronx, NY 10467 Tel:(718) 519-6900 Fax: (718) 519-6904

PWB Management Corporation 3092 Hull Avenue, Bronx, NY 10467 Tel:(718) 519-6900 Fax: (718) 519-6904 PWB Management Corporation 3092 Hull Avenue, Bronx, NY 10467 Tel:(718) 519-6900 Fax: (718) 519-6904 Dear Applicant, Enclosed is our apartment application which must be totally completed prior to submission.

More information

HYPERWALLET FEES INDIA HICKS BRANDED CARD FEES

HYPERWALLET FEES INDIA HICKS BRANDED CARD FEES We are partnering with hyperwallet/paylution to pay out your weekly and monthly commissions in the most timely and accurate way. Style Ambassadors will receive an email from Paylution to register their

More information

Making Ends Meet. Financing Your Education At Lewis SOAR 2015

Making Ends Meet. Financing Your Education At Lewis SOAR 2015 Making Ends Meet Financing Your Education At Lewis SOAR 2015 Financial Aid Checklist By now you should have: Filed the FAFSA (Free Application for Federal Student Aid) Received a Financial Aid Award Letter

More information

ROAMpay powered by ROAM

ROAMpay powered by ROAM ROAMpay powered by ROAM Table of Contents 1. Introduction 2. Setting up Service 3. Supporting ROAMpay Customers 4. Helpful Links and Contacts 5. ROAMpay User s Guide Welcome to ROAMpay powered by ROAM!

More information

Online Bank Services Agreement and Disclosure Statement INTRODUCTION GENERAL AGREEMENT AND DISCLOSURE

Online Bank Services Agreement and Disclosure Statement INTRODUCTION GENERAL AGREEMENT AND DISCLOSURE Online Bank Services Agreement and Disclosure Statement INTRODUCTION Welcome to Sierra Vista Bank, and thank you for selecting this Internet banking product. In this publication, we give you important

More information