New Merchant Dealer Setup

Size: px
Start display at page:

Download "New Merchant Dealer Setup"

Transcription

1 New Merchant Dealer Setup Instructions 1) Completely fill out the Customer Agreement Section 1, 2 & 3 to provide your terminal setup information 2) Completely fill out section 4-A or 4B depending on how you company would like to fund the account. We have supplied two options: a. Deposit on account (Section 4-A)- The merchant will supply deposit amount with ECS Wireless, LLC to determine their daily credit limit. Minimum deposit will be $200 for starter accounts and the merchant will be supplied with this amount over a two day transaction period. If the merchant wishes to raise the deposit amount they may do so at any time. If the merchant wishes to discontinue service with ECS Wireless, LLC the deposit amount will be returned in full at the merchants request. B. Credit Worthiness (Section 4-B)- If your company has a well established business credit history and personal guranter history, you may provide the business credit application in place of a deposit. Final decisions on you funding account will be based on the credit responses. 3) Fax the completed agreement to or to support@ecswireless.com with the following documents attached a. Section 1,2 and 3 b. One of the following options - section 4A or 4B c. Copy of driver s license or state ID of the Owner (Signer and Guarantor) d. Business License or Store Resell Certificate (Section 3) e. A check affiliated with the routing and account number listed in section 2 with the word void written across it. All information submitted to our company is a private NDA and will not be shared with any outside source or financial institutions. If you have any questions about the agreement or need additional assistance, please contact our office at one of the following sources: Toll Free ECS support@ecswireless.com

2 Merchant Agreement- Section 1 This agreement is between ECS Wireless, LLC / ECS Prepaid, LLC and the Business listed below as well as the Owner Operator listed below. This Business and Business Owner will be known as Merchant for future reference in this agreement. This agreement includes Sections 1, 2, 3, 4A 4B if applicable and the merchant agrees to all practices and policies included in the agreement and all sections describing those practices and polocies. 1. The Agreement shall start on the effective date listed in section 1 & 2 of this agreement and will continue until ECS Wireless, LLC terminates such Agreement or the Merchant provides a 30 day written notice and account is in good standing. 2. Product Purchasing. Merchant will be provided a virtual or manual pin terminal for electronic product (wireless pins, long distance pins, wireless TopUp and additional products) purchasing by ECS Wireless, LLC within this agreement. Merchant agrees that any and all equipment provided by ECS Wireless, LLC belongs to ECS Wireless, LLC and will be returned upon the termination of this agreement. Merchant agrees and acknowledges that any products downloaded from ECS Wireless, LLC & ECS Prepaid,LLC equipment or software are agreed as purchases and the Merchant shall pay for such purchases within the ACH transaction initiated by ECS Wireless,LLC for such purchases. Merchant agrees to all sections of this agreement describing policies and practices of such purchases. 3. Guarantor: The undersigned guarantor takes personal responsibility for any and all monies owed to ECS Wireless, LLC for purchased pins and products on the ECS Wireless, LLC system in the event that such purchases are not collected from the merchant within this agreement and guarantees payment. Payment will be due immediately in such case as monies owed are not collected from Merchant. 4. ACH Authorization: To accommodate electronic access for settlement, the Merchant does hereby authorize and instruct ECS Wireless,LLC & ECS Prepaid, LLC to access Merchant s designated depository account and to initiate credit and/or debit entries by bank wire, payment order or Automated Clearing House ( ACH ) transfer and to authorize the banking institution ( Depository ) named below to block or to initiate, if necessary, reversing entries and adjustments for any original entries made to the depository account indicated below and to authorize Depository to provide such access and to credit and/or debit or to block the same to such account. This authorization is without respect to the source of any funds in the depository account. In order to insure that transactions are properly handled, a specimen voided check is attached. Merchant shall take sole responsibility for any fees or costs associated with Merchant s financial institution including non-sufficient fees for ACH returns to ECS Wireless, LLC as well as $25 fee charged by ECS Wireless, LLC for any such ACH returns by the Merchant s financial institution. Merchant agrees that all monies owed to ECS Wireless,LLC shall be paid within 5 business days of any unpaid balances or purchases. Merchant takes responsibility for any cost of collection, including court cost and attorney fees in the event of any uncollected payments owed to ECS Wireless, LLC. 5. Licenses and Taxes: Merchant agrees it shall hold at all relevant times all appropriate tax registrations and authorizations, licenses, and permits to conduct business in all jurisdictions where it is lawfully required to do so and shall possess any necessary consents to sell ECS Wireless, LLC products and services and will not use ECS Wireless, LLC products and services for any improper or unlawful purposes, nor allow others to do so. Unless Merchant provides ECS Wireless,LLC with a valid tax exemption or resale certificate, ECS Wireless, LLC shall ACH Merchant, and Merchant shall be responsible for the payment of all lawfully due sales taxes. 6. Commissions: ECS Wireless, LLC will initiate transactions once each business day for all monies owed for products downloaded (purchased) by the Merchant and the cost minus commission value will remain in the Merchant s account for each product downloaded from ECS Wireless, LLC software or equipment 7. Acknowledgement: Your signature acknowledges that you are authorized to execute this agreement and are an authorized signatory on the attached business check, and have read and understand all information contained herein, the terms and conditions and any addenda, amendments, or attachments all of which are incorporated into this agreement. Investigative Consumer Report: An investigative or Consumer Report may be made in connection with this application. Merchant authorizes ECS Wireless, LLC and ECS Prepaid, LLC or any credit reporting agency employed by them to investigate the references given or any statements or data obtained from Merchant or any undersigned principle of Merchant for the purposes of this agreement. Business Name: Date: Fed Tax ID (EIN #): Guarantor (Print): Title: Guarantor Signature: SS #:

3 Merchant Agreement- Section 2 In Agreement with Merchant and ECS Wireless, LLC. Owner s Name (Guarantor) : Social Security # : Date of Birth : Driver s License # : State : Business Name : DBA (if applicable) : Business Operating Address : City : State : Zip : Office # : Office Fax # : Contact Contact Name (if different from Owner) : Contact Wireless # : Banking Information Bank Name : Name of Bank Account : (Note: Account name must match Owner Name or Merchant Name) Bank Account # : Bank Routing # : Branch Contact # : Contact Person ( If Applicable) : I herby state that all information supplied on my behalf and the behalf of my business location in stated to be true and give all permissions to ECS Wireless, LLC to verify such information with all authorities. Owner s Signature: Date:

4 UNIFORM SALES & USE TAX CERTIFICATE (MULTIJURISDICTION) - Section 3 The below-listed states have indicated that this form of certificate is acceptable, subject to the notes on sections 1-2. The issuer and the recipient have the responsibility of determining the proper use of this certificate under applicable laws in each state, as these may change from time to time. Issued to Seller: ECS Prepaid Address: 1615 S Ingram, Bldg B, Springfield, MO I certify that: Name of Firm (Buyer) Address: is engaged as a registered: Wholesaler Retailer Manufacturer Seller (California) Lesser (see notes pgs 2-4) Other (Specify) And is registered with the below listed states and cities within which your firm would deliver purchases to us and that any such purchases are for wholesale, resale, ingredients or components of a new product or service to be resold, leased, or rented in the normal course of business. We are in the business of wholesaling, retailing, manufacturing, leasing (renting) the following: Description of Business: General description of tangible property or taxable services to be purchased from the seller: Wireless PINs, Long Distance Phone Cards, Bill Pay Services State State Registration, Seller s Permit, or ID Number of Purchaser (Mark State Below) AL2 AR AZ22 CA 3 CO 1 CT 4 DC 5 FL 23 GA 6 HI 1, 7 ID IL 1, 8 IA KS KY ME 9 MD 10 MI 11 MN 12 MO13 NE 14 NV NJ NM 1, 15 NC 25 ND OH 26 OK 16 PA 27 RI 17 SC SD 18 TN TX 19 UT VT WA 20 WI 21 I further certify that if any property or service so purchased tax free is used or consumed by the firm as to make it subject to a Sales or Use Tax, we will pay the tax due directly to the proper taxing authority when state law so provides or inform the seller for added tax billing. This certificate shall be a part of each order which we may hereafter give to you, unless otherwise specified, and shall be valid until canceled by us in writing or revoked by the city or state. Under penalties of perjury, I swear or affirm that the information on this form is true and correct as to every material matter. Authorized Signature: (Owner, Partner or Corporate Officer) Title: Date: ECS Account Manager:

5 Depository Account Setup Section 4A (If you are providing a deposit, you will not need to fill out section 4B) For all accounts choosing depository funds Deposit will determine the credit limit of the merchants e-pin terminal. ECS Wireless, LLC will ach M,T,W,T,F for purchases made previous day. To determine your daily limit a deposit for that amount must be provided before the terminal is turned on. The deposit amount will provide the Merchant s credit limit for two business days of transactions. The deposit amount will remain on file for as long as the client has service with ECS Wireless, llc. If the Merchant discontinues service with ECS Wireless, LLC the deposit will be returned after the Merchant s last purchases have cleared the ach process. The Merchant reserves the right to increase their credit limit by adding additional deposit funds at any time. ECS Wireless, LLC reserves the right to raise the Merchant s credit limit above the deposit amount upon positive account activity. Deposit Amount : Date : Please choose form of deposit: ( ) Please ACH the banking account provided under our ach agreement for the amount listed above for my deposit funds. ( ) Our company will be providing a deposit amount via a certified check or money order which will be mailed to the office of ECS Wireless, LLC. ( ) Our company will be providing a deposit amount via credit/debit card which will be provided to ECS Wireless at their request. Merchant Name : Owner s Name (Print) : Owner s Signature :

6 ECS Wireless Business Credit Application- Section 4B Name/Address Last: First: Middle Initial: Title Name of Business: Tax I.D. Number Address: City: State: ZIP: Phone: Company Information Type of Business: In Business Since: Legal Form Under Which Business Operates: Corporation apple Partnership apple Proprietorship apple If Division/Subsidiary, Name of Parent Company: In Business Since: Name of Company Principal Responsible for Business Transactions: Title: Address: City: State: ZIP: Phone: Name of Company Principal Responsible for Business Transactions: Title: Address: City: State: ZIP: Phone: Bank References Institution Name: Institution Name: Institution Name: Checking Account #: Savings Account #: Home Equity Loan: Loan Balance: Address: Address: Address: Phone: Phone: Phone: Trade References Company Name: Company Name: Company Name: Contact Name: Contact Name: Contact Name: Address: Address: Address: Phone: Phone: Phone: Account Opened Since: Account Opened Since: Account Opened Since: Credit Limit: Credit Limit: Credit Limit: Current Balance: Current Balance: Current Balance: I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein. Signature Date ECS Office Fax

Welcome to Bay Promotions!

Welcome to Bay Promotions! Welcome to Bay Promotions! We would like to welcome you as a Bay Promotions customer! Please take a few minutes to give us your account information. This information ensures accuracy setting up your account

More information

Business Credit Application and Credit Card Authorization form

Business Credit Application and Credit Card Authorization form Business Credit Application and Credit Card Authorization form INSTRUCTIONS: If applying for Open Terms, please complete this application in its entirety. If applying for a Credit Card account, please

More information

FRAME BUILDERS & MANUFACTURERS APPLICATION. Your Guide to Creating a Successful Partnership with QBP

FRAME BUILDERS & MANUFACTURERS APPLICATION. Your Guide to Creating a Successful Partnership with QBP FRAME BUILDERS & MANUFACTURERS APPLICATION Your Guide to Creating a Successful Partnership with QBP Thank you for your interest in establishing an account with QBP. We offer frame builders and bike manufactures

More information

Attn: Credit Department 101 Security Parkway New Albany, IN 47150 Phone (800) 528-9900 Fax (812) 542-3621

Attn: Credit Department 101 Security Parkway New Albany, IN 47150 Phone (800) 528-9900 Fax (812) 542-3621 Attn: Credit Department 101 Security Parkway New Albany, IN 47150 Phone (800) 528-9900 Fax (812) 542-3621 Thank you for your interest in becoming a member of the Fire King family. We welcome the opportunity

More information

Terms & Conditions Website E-Boutique

Terms & Conditions Website E-Boutique Terms & Conditions Website E-Boutique 1. General: The following terms and conditions and any other related rules made available in writing by Bernardaud (collectively the Conditions of sale ) are applicable

More information

How To Rate Plan On A Credit Card With A Credit Union

How To Rate Plan On A Credit Card With A Credit Union Rate History Contact: 1 (800) 331-1538 Form * ** Date Date Name 1 NH94 I D 9/14/1998 N/A N/A N/A 35.00% 20.00% 1/25/2006 3/27/2006 8/20/2006 2 LTC94P I F 9/14/1998 N/A N/A N/A 35.00% 20.00% 1/25/2006 3/27/2006

More information

U.S. Department of Housing and Urban Development: Weekly Progress Report on Recovery Act Spending

U.S. Department of Housing and Urban Development: Weekly Progress Report on Recovery Act Spending U.S. Department of Housing and Urban Development: Weekly Progress Report on Recovery Act Spending by State and Program Report as of 3/7/2011 5:40:51 PM HUD's Weekly Recovery Act Progress Report: AK Grants

More information

TITLE POLICY ENDORSEMENTS BY STATE

TITLE POLICY ENDORSEMENTS BY STATE TITLE POLICY ENDORSEMENTS BY STATE State Endorsement ID Endorsement Description AK ARM ALTA 6 Adjustable (Variable) Rate AK BALLOON FNMA Balloon Endorsement AK CONDO ALTA 4 Condominium AK COPY FEE Copies

More information

An Introduction to... Equity Settlement

An Introduction to... Equity Settlement An Introduction to... Equity Settlement The New York CEMA & Co-op Process June 2009 About Us... Established in 1986 Over 100 Associates Approved Vendor for Bank of America Preferred Vendor for Many National

More information

Mortgage Broker / Mortgage Originator Bond Requirements Nationwide

Mortgage Broker / Mortgage Originator Bond Requirements Nationwide Surety One Email: Underwriting@SuretyOne.org Facsimile: 919-834-7039 Mail: P.O. Box 37284, Raleigh, NC 27627 Mortgage Broker / Mortgage Originator Bond Requirements Nationwide AK Mortgage Broker License

More information

ESCROW AGENCY APPLICATION FORM

ESCROW AGENCY APPLICATION FORM COMPANY FORM BUSINESS TYPE: ESCROW AGENCY APPLICATION FORM Escrow Construction Control Only* Type of Initial Application (check all that apply): Principal Office 1 st License Application Branch Office(s)

More information

State Corporate Income Tax-Calculation

State Corporate Income Tax-Calculation State Corporate Income Tax-Calculation 1 Because it takes all elements (a*b*c) to calculate the personal or corporate income tax, no one element of the corporate income tax can be analyzed separately from

More information

ARBITRATORS AND MEDIATORS PROFESSIONAL LIABILITY INSURANCE (This is an application for a claims-made policy.) 1. Full Name of Assured:

ARBITRATORS AND MEDIATORS PROFESSIONAL LIABILITY INSURANCE (This is an application for a claims-made policy.) 1. Full Name of Assured: ARBITRATORS AND MEDIATORS PROFESSIONAL LIABILITY INSURANCE (This is an application for a claims-made policy.) 1. Full Name of Assured: 2. Address (MUST be a Physical Address): (City) (State) (Zip) Phone

More information

Demographic Information. 17 Business Web Site Address 18 Business E-Mail Address ( ) -

Demographic Information. 17 Business Web Site Address 18 Business E-Mail Address ( ) - (Please Print or Type) Check appropriate boxes for license requested. Resident License Non-Resident License o Identify Home State: o Identify Home State License #: New Application Additional Line(s) of

More information

1. Full Name of Assured: 2. Address (MUST be a Physical Address): (City) (State) (Zip) Phone Number: ( ) Fax Number: ( ) Email Address:

1. Full Name of Assured: 2. Address (MUST be a Physical Address): (City) (State) (Zip) Phone Number: ( ) Fax Number: ( ) Email Address: ARBITRATORS, HEARING OFFICERS AND MEDIATORS PROFESSIONAL LIABILITY INSURANCE issued to the NATIONAL ASSOCIATION OF SALARIED PROFESSIONALS PURCHASING GROUP, INC. and specified members of the AMERICAN BAR

More information

Federation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Continuing Competence

Federation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Continuing Competence This document reports CEU requirements for renewal. It describes: Number of required for renewal Who approves continuing education Required courses for renewal Which jurisdictions require active practice

More information

10 Reasons Why Vertex SMB is A Better Way to Handle Your Sales and Use Tax Automation 11:00 11:30. Scott Coleman. Channel Sales Manager

10 Reasons Why Vertex SMB is A Better Way to Handle Your Sales and Use Tax Automation 11:00 11:30. Scott Coleman. Channel Sales Manager 11:00 11:30 10 Reasons Why Vertex SMB is A Better Way to Handle Your Sales and Use Tax Automation Scott Coleman Channel Sales Manager Agenda Landscape of the Market Today 10 Reasons Why Vertex SMB is a

More information

AGREEMENT FOR DISPATCH SERVICES Breaker 1-9 Full Service Dispatch

AGREEMENT FOR DISPATCH SERVICES Breaker 1-9 Full Service Dispatch AGREEMENT FOR DISPATCH SERVICES Breaker 1-9 Full Service Dispatch 1. RECITLES This agreement made as of this day of, 2014 by and between Breaker 1-9 Full Service Dispatch and, hereinafter referred to as

More information

Regional Electricity Forecasting

Regional Electricity Forecasting Regional Electricity Forecasting presented to Michigan Forum on Economic Regulatory Policy January 29, 2010 presented by Doug Gotham State Utility Forecasting Group State Utility Forecasting Group Began

More information

Federation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Continuing Competence

Federation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: Continuing Competence This document reports CEU (continuing education units) and CCU (continuing competence units) requirements for renewal. It describes: Number of CEUs/CCUs required for renewal Who approves continuing education

More information

Federation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: PTA Supervision Requirements

Federation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: PTA Supervision Requirements These tables provide information on what type of supervision is required for PTAs in various practice settings. Definitions Onsite Supervision General Supervision Indirect Supervision The supervisor is

More information

Premature: under the age of 59½ Normal: over the age of 59½, includes Required Minimum Distributions (RMD) Disability

Premature: under the age of 59½ Normal: over the age of 59½, includes Required Minimum Distributions (RMD) Disability P 1.800.962.4238 W www.pensco.com Distribution Request 1. ACCOUNT OWNER INFORMATION Please type or print all information requested below. Required fields are denoted by an * (asterisk). *First Name: *MI:

More information

Q3 USA Articulated Truck Retail Sales Promotion Date: 07/01/12-08/31/12 Program #: US-ARTIC-070112

Q3 USA Articulated Truck Retail Sales Promotion Date: 07/01/12-08/31/12 Program #: US-ARTIC-070112 Q3 USA Articulated Truck Retail Sales Promotion Date: 07/01/12-08/31/12 Program #: US-ARTIC-070112 No Distributor Participation Required. Machine Warranty Machine warranty on all Terex Artic Trucks shipped

More information

Life Settlements Source List

Life Settlements Source List BROKERS Ashar Group LLC - Life Settlement Specialists 407-772-1818 www.ashargroup.com Except AK NH VT Except AK NH VT Varies based on current market opportunities and groups that pass Ashar s due diligence

More information

Uniform Application for Business Entity Adjuster License/Registration (Please Print or Type)

Uniform Application for Business Entity Adjuster License/Registration (Please Print or Type) Business Entity License/Registration (Please Print or Type) Check appropriate box for license requested. Resident License Resident Designated Home State: License #: Non-Resident Designated Home State:

More information

New York Public School Spending In Perspec7ve

New York Public School Spending In Perspec7ve New York Public School Spending In Perspec7ve School District Fiscal Stress Conference Nelson A. Rockefeller Ins0tute of Government New York State Associa0on of School Business Officials October 4, 2013

More information

IRA Distribution Form

IRA Distribution Form Use this form to request distributions from your IRA account and to close an IRA. Instructions 1. Complete the form and include any necessary supporting documents. 2. Sign and send us the completed form.

More information

Standardized Pharmacy Technician Education and Training

Standardized Pharmacy Technician Education and Training Standardized Pharmacy Technician Education and Training Kevin N. Nicholson, RPh, JD Vice President, Pharmacy Regulatory Affairs National Association of Chain Drug Stores May 19, 2009 Overview of how technicians

More information

IRA DISTRIBUTION REQUEST

IRA DISTRIBUTION REQUEST IRA DISTRIBUTION REQUEST MAILING ADDRESS FOR OVERNIGHT NIGHT MAIL ONLY: Albuquerque, New Mexico 87190 Albuquerque, New Mexico 87112 P: 888-205-6036 F: 505-288-3905 Operations@Horizontrust.com 1. ACCOUNT

More information

NHIS State Health insurance data

NHIS State Health insurance data State Estimates of Health Insurance Coverage Data from the National Health Interview Survey Eve Powell-Griner SHADAC State Survey Workshop Washington, DC, January 13, 2009 U.S. DEPARTMENT OF HEALTH AND

More information

Federation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: License Renewal Who approves courses?

Federation of State Boards of Physical Therapy Jurisdiction Licensure Reference Guide Topic: License Renewal Who approves courses? Federation of State s of Physical The table below provides information on approval of continuing education/competence courses and for each jurisdiction. Summary Number of jurisdictions requiring approval

More information

NAAUSA Security Survey

NAAUSA Security Survey NAAUSA Security Survey 1. How would you rate the importance of each of the following AUSA security improvements. Very important Somewhat important Not too important Not at all important Secure parking

More information

NAME AND ADDRESS ADDRESS CHANGE NO OPERATION AMENDED RETURN CANCEL LICENSE LICENSE INFORMATION

NAME AND ADDRESS ADDRESS CHANGE NO OPERATION AMENDED RETURN CANCEL LICENSE LICENSE INFORMATION NEW JERSEY MOTOR VEHICLE COMMISSION MOTOR CARRIER SERVICES - IFTA SECTION 225 E. STATE STREET, PO BOX 133 TRENTON, NJ 08666-0133 PHONE: (609) 633-9400 INTERNATIONAL FUEL AGREEMENT (IFTA) QUARTERLY RETURN

More information

Credit Application. parsource.com GENERAL INFORMATION. Internal Use Only: The following documents are required to begin the application process:

Credit Application. parsource.com GENERAL INFORMATION. Internal Use Only: The following documents are required to begin the application process: The following documents are required to begin the application process: * Missing documentation could result in delays in establishing your account. ncompleted and signed credit application ncompleted Blanket

More information

ehealth Price Index Trends and Costs in the Short-Term Health Insurance Market, 2013 and 2014

ehealth Price Index Trends and Costs in the Short-Term Health Insurance Market, 2013 and 2014 ehealth Price Index Trends and Costs in the Short-Term Health Insurance Market, 2013 and 2014 June 2015 1 INTRODUCTION In this report, ehealth provides an analysis of consumer shopping trends and premium

More information

Thank you for your interest in establishing and account with Startee Apparel, Inc. To process your application, we require:

Thank you for your interest in establishing and account with Startee Apparel, Inc. To process your application, we require: DearPotentialVendor: ThankyouforyourinterestinestablishingandaccountwithStarteeApparel,Inc.Toprocessyour application,werequire: Afullycompletedandsignedapplicationwith4tradereferencesandbanking information

More information

Offer in Compromise. Attach Application Fee and Payment (check or money order) here. IRS Received Date. (Rev. May 2012) Section 3

Offer in Compromise. Attach Application Fee and Payment (check or money order) here. IRS Received Date. (Rev. May 2012) Section 3 Form 656 (Rev. May 2012) Department of the Treasury Internal Revenue Service Offer in Compromise Attach Application Fee and Payment (check or money order) here. Section 1 Your Contact Information Your

More information

PART I - IDENTIFICATION AND PERSONAL INFORMATION 1D. VA FILE NUMBER. CHAPTER 1606 (Montgomery GI Bill - Selected Reserve

PART I - IDENTIFICATION AND PERSONAL INFORMATION 1D. VA FILE NUMBER. CHAPTER 1606 (Montgomery GI Bill - Selected Reserve OMB Approved No 2900-0074 Respondent Burden: 20 minutes REQUEST FOR CHANGE OF PROGRAM OR PLACE OF TRAINING (Under Chapters 30 and 32, Title 38, USC; Chapters 1606 and 1607, Title 10, USC and Section 903

More information

The Lincoln National Life Insurance Company Variable Life Portfolio

The Lincoln National Life Insurance Company Variable Life Portfolio The Lincoln National Life Insurance Company Variable Life Portfolio State Availability as of 12/14/2015 PRODUCTS AL AK AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MP MD MA MI MN MS MO MT NE

More information

COMPREHENSIVE COVERAGE

COMPREHENSIVE COVERAGE COMPREHENSIVE COVERAGE IN YOUR POCKET Comprehensive Coverage Explained: A Pocket Guide to Understanding the Difference Between Homeowners Insurance, Home Warranty Service Agreements and New Construction

More information

State Annual Report Due Dates for Business Entities page 1 of 10

State Annual Report Due Dates for Business Entities page 1 of 10 State Annual Report Due Dates for Business Entities page 1 of 10 If you form a formal business entity with the state, you may be required to file periodic reports on the status of your entity to preserve

More information

WAREHOUSE LINE APPLICATION 1 COMPANY INFORMATION (MAIN OFFICE OR PARENT COMPANY) 2 CORPORATE FILING INFORMATION

WAREHOUSE LINE APPLICATION 1 COMPANY INFORMATION (MAIN OFFICE OR PARENT COMPANY) 2 CORPORATE FILING INFORMATION WAREHOUSE LINE APPLICATION 1 COMPANY INFORMATION (MAIN OFFICE OR PARENT COMPANY) Business Name: Company Contact Doing Business As: Contact Phone Number: Physical Address (Cannot be a PO Box) City, State,

More information

Distribution Request for Payment of Qualified Health and Long-Term Care Insurance Premiums THE CITY OF SEATTLE VOLUNTARY DEFERRED COMPENSATION PLAN

Distribution Request for Payment of Qualified Health and Long-Term Care Insurance Premiums THE CITY OF SEATTLE VOLUNTARY DEFERRED COMPENSATION PLAN Instructions Distribution Request for Payment of Qualified Health and Long-Term Care Insurance Premiums THE CITY OF SEATTLE VOLUNTARY DEFERRED COMPENSATION PLAN Retired Public Safety Officers can use this

More information

esign Borrower Experience

esign Borrower Experience esign Borrower Experience Below is a step-by-step synopsis of the borrower experience during the esign process. Borrower receives greeting message from docs@primelending.com with a Doc Link. Note: This

More information

LIMITED LIABILITY COMPANY ORGANIZATION CHART

LIMITED LIABILITY COMPANY ORGANIZATION CHART LIMITED LIABILITY COMPANY ORGANIZATION CHART The following Chart has been designed to allow you in a summary format, determine the minimum requirements to form a limited liability company in all 50 states

More information

If assigned, National Producer Number (NPN)

If assigned, National Producer Number (NPN) Individual or Apprentice License/Registration (Please Print or Type) Check appropriate box for license requested. Resident License Resident Designated Home State: License #: Non-Resident Designated Home

More information

Breakeven Cost for Residential Photovoltaics in the United States: Key Drivers and Sensitivities (Report Summary)

Breakeven Cost for Residential Photovoltaics in the United States: Key Drivers and Sensitivities (Report Summary) Breakeven Cost for Residential Photovoltaics in the United States: Key Drivers and Sensitivities (Report Summary) Paul Denholm Robert M. Margolis Sean Ong Billy Roberts December 2009 NREL/PR-6A2-47248

More information

Table 12: Availability Of Workers Compensation Insurance Through Homeowner s Insurance By Jurisdiction

Table 12: Availability Of Workers Compensation Insurance Through Homeowner s Insurance By Jurisdiction AL No 2 Yes No See footnote 2. AK No Yes No N/A AZ Yes Yes Yes No specific coverage or rate information available. AR No Yes No N/A CA Yes No No Section 11590 of the CA State Insurance Code mandates the

More information

Surety Bond Requirements for Mortgage Brokers and Mortgage Bankers As of July 15, 2011

Surety Bond Requirements for Mortgage Brokers and Mortgage Bankers As of July 15, 2011 Surety Bond Requirements for Mortgage Brokers and Mortgage Bankers As of July 15, 2011 State Mortgage Broker Bond Cancellation Mortgage Banker Bond Cancellation Notes & Citations AK $75,000 minimum for

More information

State Survey Results MULTI-LEVEL LICENSURE TITLE PROTECTION

State Survey Results MULTI-LEVEL LICENSURE TITLE PROTECTION MULTI-LEVEL LICENSURE TITLE PROTECTION Prior AK MN TN MO AL MO KY VA AZ MS MO DC NYC NE HI ME OR IA RI PA IL TX VA KS WA LA WI MA WV Prior AK ME OR TN AL MI PA HI CO MS FL DC NC MN IA NE UT IL NV WA IN

More information

Florida Workers Comp Market

Florida Workers Comp Market Florida Workers Comp Market 10/5/10 Lori Lovgren 561-893-3337 Lori_Lovgren@ncci.com Florida Workers Compensation Rates 10-1-03 1-1-11 to 1-1-11* Manufacturing + 9.9% 57.8% Contracting + 7.3% 64.4 % Office

More information

Who provides this training? Are there any requirements? The parents/guardians and the doctor go through the medication curriculum with the student.

Who provides this training? Are there any requirements? The parents/guardians and the doctor go through the medication curriculum with the student. AL AK AZ AR Student, if they have a chronic condition school nurse or school administrators The student, if their parent/guardian authorizes them to. Trained school personnel can also administer Students

More information

Health Workforce Data Collection: Findings from a Survey of States

Health Workforce Data Collection: Findings from a Survey of States Health Workforce Data Collection: Findings from a Survey of States Jean Moore, DrPH David Armstrong, PhD Health Workforce Technical Assistance Center School of Public Health University at Albany, SUNY

More information

Required Minimum Distribution Election Form for IRA s, 403(b)/TSA and other Qualified Plans

Required Minimum Distribution Election Form for IRA s, 403(b)/TSA and other Qualified Plans Required Minimum Distribution Election Form for IRA s, 403(b)/TSA and other Qualified Plans For Policyholders who have not annuitized their deferred annuity contracts Zurich American Life Insurance Company

More information

The following rates are the maximum rates that should be illustrated. Be sure to update the IRIS illustration system

The following rates are the maximum rates that should be illustrated. Be sure to update the IRIS illustration system INTEREST RATES - June 16, 2016 to July 15, 2016 Notices 1. Before soliciting or taking any annuity applications, it is required that you have completed Lafayette Life's Annuity Training and any Continuing

More information

Department of Legislative Services

Department of Legislative Services Department of Legislative Services Maryland General Assembly 2008 Session HB 1169 FISCAL AND POLICY NOTE House Bill 1169 Ways and Means (Delegate Barve) Sales and Use Tax - Computer Services Exemption

More information

How to Eliminate Your Tax Debt

How to Eliminate Your Tax Debt How to Eliminate Your Tax Debt Bankruptcy Solutions for Tax-Burdened Individuals A White Paper Presented by MARKOWITZ O DONNELL How To Eliminate Your Tax Debt Bankruptcy Solutions for Tax-Burdened Individuals

More information

Payroll Tax Chart Results

Payroll Tax Chart Results Payroll Tax Chart Results Terminated Employee -- Involuntary Terminated Employee -- Vacation Pay Terminated Employee -- Voluntary Taxing Authority Federal Payment Date for Involuntary Termination No provision

More information

Ambulance Industry Receives Financial Relief Through the MMA

Ambulance Industry Receives Financial Relief Through the MMA Ambulance Industry Receives Financial Relief Through the MMA On June 25, 2004, the Centers for Medicare and Medicaid Services (CMS) issued Transmittal 220 to Medicare Contractors outlining changes to the

More information

PRODUCTS CURRENTLY AVAILABLE FOR SALE. Marquis SP

PRODUCTS CURRENTLY AVAILABLE FOR SALE. Marquis SP INTEREST RATES - August 16, 2016 to September 15, 2016 Notices 1. Before soliciting or taking any annuity applications, it is required that you have completed Lafayette Life's Annuity Training and any

More information

STC Insured Deposit Program (STID) Updated 06/16/2016

STC Insured Deposit Program (STID) Updated 06/16/2016 STC Insured Deposit Program (STID) Welcome to the AIG Federal Savings Bank ( AIG FSB ), d/b/a SunAmerica Trust Company ( STC ) STC Insured Deposit Program. Under this program, available cash balances (from

More information

U.S. Department of Education NCES 2011-460 NAEP. Tools on the Web

U.S. Department of Education NCES 2011-460 NAEP. Tools on the Web U.S. Department of Education NCES 2011-460 NAEP Tools on the Web Whether you re an educator, a member of the media, a parent, a student, a policymaker, or a researcher, there are many resources available

More information

AmGUARD Insurance Company EastGUARD Insurance Company NorGUARD Insurance Company WestGUARD Insurance Company GUARD

AmGUARD Insurance Company EastGUARD Insurance Company NorGUARD Insurance Company WestGUARD Insurance Company GUARD About Us For over 30 years, we have protected the interests of the small- to mid-sized businesses that insure with us. At Berkshire Hathaway Insurance Companies, we dedicate our efforts in the areas that

More information

United States Bankruptcy Court District of Arizona NOTICE TO: DEBTOR ATTORNEYS, BANKRUPTCY PETITION PREPARERS AND DEBTORS

United States Bankruptcy Court District of Arizona NOTICE TO: DEBTOR ATTORNEYS, BANKRUPTCY PETITION PREPARERS AND DEBTORS United States Bankruptcy Court District of Arizona NOTICE TO: DEBTOR ATTORNEYS, BANKRUPTCY PETITION PREPARERS AND DEBTORS UPDATED REQUIREMENTS FOR FORMAT OF MASTER MAILING LIST The meeting of creditors

More information

Understanding Payroll Recordkeeping Requirements

Understanding Payroll Recordkeeping Requirements Understanding Payroll Recordkeeping Requirements 1 Presented by Sally Thomson, CPP Directory of Payroll Training American Payroll Association sthomson@americanpayroll.org 2 Agenda Recordkeeping Requirements

More information

CDFI FUND NEW MARKETS TAX CREDIT PROGRAM:

CDFI FUND NEW MARKETS TAX CREDIT PROGRAM: CDFI FUND US Department of the Treasury NEW MARKETS TAX CREDIT PROGRAM: SECOND ROUND (2003-2004) Allocatees Serving Allocatee Name (Award Amount) AK 1 Alaska Growth Capital BIDCO, Inc. ($35 million) Total:

More information

American Equity Investment Life Insurance Company Bonus Gold (Index 1-07) PFG Marketing Group, Inc.

American Equity Investment Life Insurance Company Bonus Gold (Index 1-07) PFG Marketing Group, Inc. A Fixed Indexed Annuity with a 16-year surrender period. This product is not available in AK AL CT DE MN NJ NV NY OH OK OR PR TX UT VI WA Ratings A.M. Best : A- Standard & Poor's: BBB+ 1 Year S&P 500 Annual

More information

LexisNexis Law Firm Billable Hours Survey Report

LexisNexis Law Firm Billable Hours Survey Report LexisNexis Law Firm Billable Hours Survey Report Executive Summary Despite the critical impact on a firm s bottom line, it remains challenging for some attorneys and legal staff to efficiently capture

More information

Athene Annuity (DE) Rates

Athene Annuity (DE) Rates January 29, 2015 Athene Annuity (DE) s Athene Benefit 10 SM, Athene Choice, Athene Max and Athene 7 MYG SM rates will remain unchanged for the Athene Annuity (DE) product series. Guaranteed payout rates

More information

Prescription Drug Marketing Act (PDMA): Understanding the Regulations

Prescription Drug Marketing Act (PDMA): Understanding the Regulations Prescription Drug Marketing Act (PDMA): Understanding the Regulations Ron Greenbaum, RPh Director of Compliance and QA Dendrite Interactive Marketing BuzzeoPDMA, Totowa, NJ Agenda - PDMA Introduction Purpose

More information

PART I - APPLICANT INFORMATION. 7. TELEPHONE NUMBER(S) (Including Area Code) SECONDARY

PART I - APPLICANT INFORMATION. 7. TELEPHONE NUMBER(S) (Including Area Code) SECONDARY 1. NAME (First, Middle Initial, Last) DEPENDENTS' REQUEST FOR CHANGE OF PROGRAM OR PLACE OF TRAINING (Under Provisions of Chapters 33 and 35, Title 38, U.S.C.) INTERNET VERSION AVAILABLE - You may complete

More information

Legal Concepts Meet Technology: A 50 State Survey of Privacy Laws

Legal Concepts Meet Technology: A 50 State Survey of Privacy Laws Legal Concepts Meet Technology: A 50 State Survey of Privacy Laws Miriam B. Russom University of Illinois at Chicago, Computer Science Department Robert H. Sloan University of Illinois at Chicago, Computer

More information

Enrollment Snapshot of Radiography, Radiation Therapy and Nuclear Medicine Technology Programs 2013

Enrollment Snapshot of Radiography, Radiation Therapy and Nuclear Medicine Technology Programs 2013 Enrollment Snapshot of Radiography, Radiation Therapy and Nuclear Medicine Technology Programs 2013 A Nationwide Survey of Program Directors Conducted by the American Society of Radiologic Technologists

More information

Travelers Auto and Home Insurance Program

Travelers Auto and Home Insurance Program Travelers Auto and Home Insurance Program ENHANCE YOUR CREDIT UNION MEMBER BENEFITS, NOT YOUR COSTS A plan for your credit union Enhance your member benefits, not your costs It s a fact. Good member benefits

More information

THE TATITLEK CORPORATION 401(K) PLAN FINAL DISTRIBUTION FORM (888) 477-3135

THE TATITLEK CORPORATION 401(K) PLAN FINAL DISTRIBUTION FORM (888) 477-3135 Return Form To: Northwest Plan Services, Inc. 5446 California Ave SW Suite 200 Seattle, WA 98136 Fax (206) 938-5987 THE TATITLEK CORPORATION 401(K) PLAN FINAL DISTRIBUTION FORM (888) 477-3135 Participant

More information

CINCINNATI HILLS CHRISTIAN ACADEMY COLLEGE QUESTIONNAIRE FOR STUDENTS

CINCINNATI HILLS CHRISTIAN ACADEMY COLLEGE QUESTIONNAIRE FOR STUDENTS CINCINNATI HILLS CHRISTIAN ACADEMY COLLEGE QUESTIONNAIRE FOR STUDENTS Complete & bring with you to your Junior College Planning Meeting. NAME: ADDRESS: EMAIL: BIRTHDATE: PHONE #: DATE: PLEASE READ BEFORE

More information

State Special Education Forms September 2002 Eileen M. Ahearn, Ph.D.

State Special Education Forms September 2002 Eileen M. Ahearn, Ph.D. QTA A brief analysis of a critical issue in special education Special Education s September 2002 Eileen M. Ahearn, Ph.D. Purpose and Method One of the major issues mentioned in connection with the pending

More information

Final Expense Life Insurance

Final Expense Life Insurance Dignified Choice - Classic Series Final Expense Life Insurance Columbian Mutual Life Insurance Company Home Office: Binghamton, NY Administrative Service Office: Norcross, GA Columbian Life Insurance Company

More information

United States Bankruptcy Court District of Arizona

United States Bankruptcy Court District of Arizona United States Bankruptcy Court District of Arizona NOTICE TO: DEBTOR ATTORNEYS, BANKRUPTCY PETITION PREPARERS AND DEBTORS UPDATED REQUIREMENTS FOR FORMAT OF MASTER MAILING LIST The meeting of creditors

More information

States Served. CDFI Fund 601 Thirteenth Street, NW, Suite 200, South, Washington, DC 20005 (202) 622-8662 25

States Served. CDFI Fund 601 Thirteenth Street, NW, Suite 200, South, Washington, DC 20005 (202) 622-8662 25 s Served CDFI Fund 601 Thirteenth Street, NW, Suite 200, South, Washington, DC 20005 (202) 622-8662 25 New Markets Tax Credit Program Sixth Round (2008) s Served NOTES: (1) Allocatees that are italicized

More information

Suitability Agent Continuing Education Requirements by State

Suitability Agent Continuing Education Requirements by State Suitability Agent Continuing Education Requirements by State STATE AL AK AZ AR CA CO CT DE DC FL GA HI ID Insurance producers holding a life line of insurance license must complete a one-time 4 hour annuity

More information

Reverse Mortgage Source List

Reverse Mortgage Source List 1st Financial 800-20-003 www.firstloans.net HECM FL MD MI SC 25 Depends on the circumstances. Advanced Mortgage Services 81-659-6555 www.ams-loan.com MA 6 Please call for updated rates and closing fees.

More information

FILING MEMORANDUM ITEM U-1399A REVISIONS TO STATISTICAL PLAN FOR WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE AMENDED PENSION TABLE VALUES

FILING MEMORANDUM ITEM U-1399A REVISIONS TO STATISTICAL PLAN FOR WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE AMENDED PENSION TABLE VALUES (Applies in: AK, AL, AR, AZ, CO, CT, DC, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MD, ME, MO, MS, MT, NE, NH, NM, NV, OK, OR, RI, SC, SD, TN, UT, VA, VT, WV) PAGE 1 FILING MEMORANDUM To become effective

More information

FOREIGN LIMITED LIABILITY COMPANY REGISTRATION CHART

FOREIGN LIMITED LIABILITY COMPANY REGISTRATION CHART FOREIGN LIMITED LIABILITY COMPANY REGISTRATION CHART When a Limited Liability Company desires to transact business in a jurisdiction other than its state of formation it must comply with the statutes of

More information

Trends in Medigap Coverage and Enrollment, 2011

Trends in Medigap Coverage and Enrollment, 2011 Trends in Medigap Coverage and Enrollment, 2011 May 2012 SUMMARY This report presents trends in enrollment in Medicare Supplement (Medigap) insurance coverage, using data on the number of policies in force

More information

State and Local Sales Tax Revenue Losses from E-Commerce: Estimates as of July 2004

State and Local Sales Tax Revenue Losses from E-Commerce: Estimates as of July 2004 State and Local Sales Tax Revenue Losses from E-Commerce: Estimates as of July 2004 by Dr. Donald Bruce, Research Assistant Professor dbruce@utk.edu and Dr. William F. Fox, Professor and Director billfox@utk.edu

More information

Business Address (Physical Street) 19 P.O. Box 20 City 21 State 22 Zip Code 23 Foreign Country

Business Address (Physical Street) 19 P.O. Box 20 City 21 State 22 Zip Code 23 Foreign Country Individual Producer License/Registration (Please Print or Type) Check appropriate boxes for license requested. Resident License Non-Resident License Identify Home State: Home State License #: New Application

More information

Preapproval Inspections for Manufacturing. Christy Foreman Deputy Director Division of Enforcement B Office of Compliance/CDRH

Preapproval Inspections for Manufacturing. Christy Foreman Deputy Director Division of Enforcement B Office of Compliance/CDRH Preapproval Inspections for Manufacturing Christy Foreman Deputy Director Division of Enforcement B Office of Compliance/CDRH Major Steps Review of the Quality System information Inspection requests generated

More information

FORM D Notice of Exempt Offering of Securities

FORM D Notice of Exempt Offering of Securities You may not send a completed printout of this form to the SEC to satisfy a filing obligation. You can only satisfy an SEC filing obligation by submitting the information required by this form to the SEC

More information

CONTINGENT COVERAGES AVAILABLE FOR AUTO LESSORS

CONTINGENT COVERAGES AVAILABLE FOR AUTO LESSORS CONTINGENT COVERAGES AVAILABLE FOR AUTO LESSORS LESSORS CONTINGENT LIABILITY $100,000 per person, $300,000 per occurrence, Bodily Injury; and $50,000 per occurrence, Property Damage ($100/300/50). As the

More information

In Utilization and Trend In Quality

In Utilization and Trend In Quality AHA Taskforce on Variation in Health Care Spending O Hare Hilton, Chicago February 10, 2010 Allan M. Korn, M.D., FACP Senior Vice President, Clinical Affairs and Chief Medical Officer Variation In Utilization

More information

Dashboard. Campaign for Action. Welcome to the Future of Nursing:

Dashboard. Campaign for Action. Welcome to the Future of Nursing: Welcome to the Future of Nursing: Campaign for Action Dashboard About this Dashboard: These are graphic representations of measurable goals that the Campaign has selected to evaluate our efforts in support

More information

Premium Reverse Mortgage Leads (Silver Financial, Inc.) 105 W Adams St, #1325, Chicago, IL 60603 1-800-854-8673 fidess.ferrer@premiumreverse.

Premium Reverse Mortgage Leads (Silver Financial, Inc.) 105 W Adams St, #1325, Chicago, IL 60603 1-800-854-8673 fidess.ferrer@premiumreverse. Premium Reverse Mortgage Leads (Silver Financial, Inc.) 105 W Adams St, #1325, Chicago, IL 60603 1-800-854-8673 fidess.ferrer@premiumreverse.com Summary Premium Reverse is a lead generation company specializing

More information

Funding for Accreditation of Medicolegal Death Investigation Offices and Certification of Medicolegal Death Investigation Personnel

Funding for Accreditation of Medicolegal Death Investigation Offices and Certification of Medicolegal Death Investigation Personnel 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 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Funding for Accreditation of Medicolegal Death Investigation Offices and

More information

Cloud Computing and Affiliate Nexus

Cloud Computing and Affiliate Nexus Cloud Computing and Affiliate Nexus Jonathan Feldman Charlie Kearns Eric Tresh July 20, 2011 1 Agenda Cloud Computing What is Cloud Computing? Nexus Characterization Determines Taxability State Taxability

More information

Moving TIM from Good to Great?

Moving TIM from Good to Great? FHWA Update: Traffic Incident Management Program Moving TIM from Good to Great? Iowa Traffic Safety Forum November 19, 2014 Mr. Jeff King (Retired Capt. AzDPS) Traffic Incident Management Public Safety

More information

What does Georgia gain. by investing in its

What does Georgia gain. by investing in its What does Georgia gain by investing in its colleges and universities 2 A tremendous return: More economic prosperity. Less government spending. A stronger competitive advantage. A higher quality of life.

More information

GE Inventory Finance. Unlock your cash potential.

GE Inventory Finance. Unlock your cash potential. GE Inventory Finance Unlock your cash potential. Benefits of Floor Planning Increased sales Interest-free extended terms Ecommerce / Customer Online Management Systems (COMS) (Purchase Approvals / Inventory

More information

What you need to know about your account

What you need to know about your account The information in this disclosure may not be entirely accessible to screen readers. If you have any questions please contact your Wells Fargo banker or call our National Business Banking Center at 1-800-225-5935.

More information

Download at www.iii.org/presentations

Download at www.iii.org/presentations Residual Markets, Uninsured Motorists and Competition in Maryland Auto Insurance Maryland Auto Insurance Plan Senate Hearing on Uninsured Motorists Annapolis, MD December 16, 2015 Download at www.iii.org/presentations

More information