Returned Check Policy. If a payment is made on an account by check, and the check is returned as Non-Sufficient Funds (NSF), Account Closed (AC), or Refer to Maker (RTM), the patient or the Patient’s Responsible Party will be responsible for the original check amount in addition to a $35.00 service charge. Once notice is received of the returned check, this office will contact the Responsible Party of the returned check. If a response is not made within 15 days from the date of contact by the Patient or the Responsible Party, the account may be turned over to our collection agency and a collection fee will be added to the outstanding balance – in addition to the $35.00 Check Service Charge.
Returned Check Policy. In the event any check is returned for non-payment, Guardian agrees to pay a returned check fee in the amount of $30.00 plus all costs of collection including, but not limited to, attorney’s fees and costs. I/We have read and understood this Agreement and agree to be bound by all terms and conditions of this Agreement and the documents incorporated into this Agreement. The terms of this Agreement will apply to all Services provided under this Agreement. Dated: (Guardian Signature) By: , Guardian (Guardian Print Name) CLIENT INTERVIEW & APPLICATION Guardian’s Information Name: Address: City: Zip: Home Phone: Cell Phone: Employer: Work Phone: Email: Emergency person to contact in case we cannot reach you: Name: Phone: How did you hear about Wacky Wags Doggie Daycare Center? Veterinarian Information Name/Hospital: Address: Phone: Fax: Pet Information Pet #1: Name: Breed: Birthday: Color: Weight: M / F (circle one) Spayed / Neutered (circle one) Pet #2: Name: Breed: Birthday: Color: Weight: M / F (circle one) Spayed / Neutered (circle one) Pet#3: Name: Breed: Birthday: Color: Weight: M / F (circle one) Spayed / Neutered (circle one) Pet Personality Profile #1 Pet’s Name: How long have you had your Pet? Where did you get your Pet? If adopted, do you have any information on your pet’s history? Circle all that describe your pet’s personality: Outgoing / verbally sensitive / timid / pushy / affectionate / submissive / insecure or clingy / excitable / playful / gentle / quiet or subdued / mouthy / other: Describe your pet’s activity level (circle one): Low / Medium / High How would you describe your Pet’s demeanor while riding in a car (circle one)? Enjoys / Dislikes / Neutral Is your pet crate trained? (circle one): Yes / No Circle all situations where your Pet may become unfriendly / react in a negative and/or aggressive manner: Grabbing collar / hugging / removing from furniture / touching while sleeping / touching ears, paws, mouth, tail Other: If you answered yes to any of the above questions, please circle the behavior/reaction that best describes your Pet in the aforementioned situation: Will bite / May bite / Growls / Shows teeth / Trembles / Moves away Does your Pet have any noise sensitivities? Does your Pet like children? Which flea preventative do you use? When was it last administered? Does your Pet have any health or physical issues that would cause restrictions on activities or movements? Does your Pet have any allergies? If yes, describe reaction: D...
Returned Check Policy. Licensee will be charged an additional $25.00 for returned checks in addition to any other monies owed such as the Rental Fee and/or deposit.
Returned Check Policy. In the event that a check is returned to Don’t Stop Bouncing! LLC for insufficient funds customer agrees to pay the total rental price as well as an additional $20.00 fee to Don’t Stop Bouncing! LLC. In cash immediately upon notice.
Returned Check Policy. I understand and agree to pay a $35.00 processing fee for any check that is returned from the bank. I agree to pay all future tuition in cash or money order, should two checks be returned from the bank.
Returned Check Policy. For each check returned, the City of Moscow fee schedule permits the City to charge a $25 service charge to the rider. In addition, the rider must purchase a money order or pay in cash, credit card, or certified check to replace the returned check.
Returned Check Policy. It is understood and agreed that upon presentation of a check as the form of payment for services provided by Service Provider, that I am entering into a contractual agreement that obligates me and holds me responsible for any and all penalties, costs, and incidental damages allowable under law, but not limited to, return check charges, state surcharges, interest, collection costs, legal expenses, attorney fees and expenses incidental to the principal obligation on any check that is returned non-payable. Any check returned unpaid for any reason will not be re-deposited. Buyer agrees to pay the full amount of the check plus a returned check fee of $25.00 for amounts up to $50, $30 for amounts between $50 and $300, or $40 if the face value exceeds $300, within 5 business days of the date that the check was returned unpaid. Payment must be made in the form of cash or certified check. If payment is not received within five (5) business days, buyer understands and agrees that Service Provider will charge an additional 1.5% late payment fee upon the sixth (6th) business day and an additional 1.5% per month thereafter. Xxxxx understands and agrees that if upon the fifteenth (15th) business day, the returned check remains unpaid Service Provider may turn over the dishonored check and all other available information relating to this incident to the State Attorney for criminal prosecution. Buyer may be additionally liable in a civil action for triple the amount of the check, but in no case less than $50, together with the amount of the check, as service charge, courts costs, reasonable attorney fees, and incurred bank fees.
Returned Check Policy. In the event that a check is returned to Jamaya party Rentals for insufficient funds customer agrees to pay the total rental price as well as an additional $75.00 fee to Jamaya party Rentals in cash immediately upon notice.
Returned Check Policy. The City of Maynardville and the Maynardville Utility Department offices will charge a $35.00 processing fee for all returned checks and/or credit card payments. Customers who have a returned check will not be able to write a check and/or make a credit card payment for 1 year after the date. If the customer has a returned check for a reconnection fee then an additional $50.00 reconnection fee will be charged in addition to the original reconnection fee. WATER SYSTEM CROSS‐CONNECTION SURVEY RESIDENTIAL Occupant Name Occupant Address 1. OWN RENT
Returned Check Policy. If any checks are returned because of insufficient funds, SCAUG will charge a $25 fee. Registrants will also be required to pay the amount SCAUG is charged by the financial institution that returned the check. SCAUG reserves the right to refuse to honor future checks submitted by violators. Effective dates: 20 - 20 Regional SCAUG President Date Oklahoma State Representative Date
