PDF-Authorized Signature

Title Date We agree to abide by all contract terms and conditions as set forth on the back on this document along with any forthcoming guidelines See ocial rules and regulations on reverse side f. S Department of Health Human Services Office for Civil Rights 200 Independence Ave SW Washington DC 20201 Name and Title of Authorized Official please print or type ASSURANCE OF COMPLIANCE ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS AC Rupees for value received together with interest at the rate of Floating rate per annum with or such other rates which Bajaj may specify from time to im e Presentment for payment and noting and protest of the note are hereby unconditionally wai Signature discrepancies may cause significant delays. SRI06 REQUEST FOR URGENT PROCESSING Please complete using BLOCK letters Mail to: Skills Recognition International VETASSESS 5 /478 Albert Stree Authorized Signature X Roseville, CA 95747 Phone (916) 771-0775 Fax (916) 771-5634 Payment Method: (check one) Cash Money Order AutoPay Credit Card (If using a different Credit Signature Authorization) Date If Signed b y Person Other Than Patient , Provide Reason, Relationship to Patient, Description o f Their Authority PT.NO NAME DOB UW Medicine Harborview Medical Center Company Approved for Manufacturing Project Name Authorized Signature Name Written Clearly Date Model 8972-JET-ALNeo-Tub/Double Wall - Angled Leftwith Hydromassage Jetting 8972-JETSatin Stainless Steel Page 1 of 2 Student Activities Business Office (SABO) Authorized Signature Form Student Government Activity Fund ( SGAF ) Student Organization Activity Fund ( SOAF ) Club or Organization Name: B Date Requested Pager User Work Number (of authorized person) (______) _________________________ 5000 the Presidents Club2500 Presidents Club Renewal1000 Gold Eagle500 Silver Eagle250 Bronze Eagle OtherI prefer to use my personal credit card Please charge my credit card All credit card pledges SARGENT KESO SECURITY SYSTEMRegister NoKeso F1Keso StandardJobAddressDistributorAddressPERSONS AUTHORIZED TO ORDER ADDITIONAL LOCKSETS CYLINDERS OR KEYSSignatureTitleName please type or printSignature corpinfostatesdusThe undersigned corporate officers general partner of a limited partnership or holder of reserved or registered name 1The followingentityGrants consent to use of thisnameAnd the grant 2 Click on Account Information3 Click on the 4 Click on the ill allow a parent guardian 5 Enter in the email address of the authorized user 6 You have the option to allow this person to view your bill USERS WHAT YOU NEED TO KNOWThe BasicsThe concept is a simple one online accounts are Owners who can designate who can file documents onthat entity the Authorized FilerHow do I become an Owner1Create a