Name_______________________________ Soc. Sec. No. ___________
Address____________________________ Dr. Lic. No. ____________
City_______________________________ Telephone________________
In Emergency Notify________________ Relationship_____________
Address____________________________ Telephone________________
Physician__________________________ Telephone________________
Dentist____________________________ Telephone________________
Medication Currenty Taking___________________________________
Insurance______________________________ #____________________
This form has been completed on (date)
TO:_______________________
The undersigned for the purpose of procuring and establishing
credit from time to time with you and further, to induce you
to permit the undersigned to become indebted to you on notes,
endorsements, guarantees, overdrafts or otherwise, furnishes
the following (or in lieu thereof the attached) which is the
most recent statement prepared by or for the undersigned as
being a full, true and correct statement of the financial
condition of the undersigned on the date indicated, and
agrees to notify you immediately of the extent and character
of any material change in said financial condition, and also
agrees that if the undersigned, or any endorser or guarantor
of any of the obligations of the undersigned, at any time
fails in business or becomes insolvent, or commits an act of
bankruptcy, or dies, or if a writ of attachment, garnishment,
execution or other legal process be issued against property
of the undersigned or if any assessment for taxes against the
undersigned, other than taxes on real property, is made by
the federal or state government or any department theeof, or
if any of the representations made below prove to be untrue,
or if the undersigned fails to notify you of any material
change as above agreed, or if such change occurs, or if the
business, or any interest therein, of the undersigned is sold,
then and in such case, all of the obligations of the
undersigned to you or held by you shall immediately be due
and payable, without demand or notice. This statement shall
be construed by you to be a continuing statement of the
condition of the undersigned, and a new and original statement
of all assets and liabilities upon each and every transaction
and by which the undersigned hereinafter becomes indebted to
you, until the undersigned advises in writing to the contrary.
____________________
Date:_______________ (Signature)
FOR GOOD CONSIDERATION, the undersigned irrevocably
authorizes _, and its successors and assigns to use, publish
or reprint in whole or in part the following statement,
picture, endorsement or quotation: (Describe or attach)
_
This authorization shall extend only to a certain
publication known as _, including all new editions, reprints,
advertisements, publicity and promotions thereto of said work.
Dated: _
_______________________________
FOR GOOD CONSIDERATION, the undersigned, as copyright
holder, hereby grants permission to _, to reprint, publish and
use for world distribution the following material: (Describe
or attach)
_
This material shall be used only in the following manner
or publication: (Define intended use)
_
A credit line to acknowledge use of the material is _____
is not _____ (Check one) required. If required, the credit
line shall read as follows:
_
Dated: _
_______________________________
Permission to Discuss Consumer File
TO: (name of consumer agency)
Permission is hereby granted for (name of consumer reporting
agency) to discuss the information about me contained in
their file in the presence of (name of third party)
_______________________
(Signature)
Date: _
To: _
We enclose our check in the amount of $_, to be credited
to the following invoices only:
Invoice/Debt Amount
_ _
_ _
_ _
_ _
Very truly,
______________________________
COME CELEBRATE WITH US!
We are previewing our NEW PRODUCT LINE on
Thursday, June 17, 1986. We will be waiting
for you at HAL’S STEAKHOUSE, at 1324 Culver Way
in CENTURY CITY.
The PARTY starts at 10:00 a. m. and continues
until 10:00 p.m.
We’ll WINE YOU AND DINE YOU.
WE ARE LOOKING FORWARD TO SEEING YOU THERE.
Dear
We have received the part for your (appliance).
Several attempts have been made to contact you in order
to complete your repairs.
Please telephone us at (number) so that arrangements
can be made to come to your home and complete this work.
The total cost of the part is $ , including sales tax.
This amount will be payable at the time of installation.
Thank you.
Dear
We are happy to be able to inform you that the parts you
ordered are now in stock and available for pick up at the
above address.
Please accept our sincerest apologies for the delay in
delivery and we thank you for your patience in this matter.
As always, it is our full intent to provide you with
dependable and quality service, and in keeping with this
goal, we appreciate your understanding in waiting.
If we may be of further assistance, please call upon us at
any time.
Dear
Our records indicate that payment on your account is
overdue in the amount of $ . If the amount has
already been paid, please disregard this notice. If
you have not yet mailed your payment, why not make out
your check and place it in the enclosed envelope while
this reminder is has your full attention.
Thank you in advance for your anticipated cooperation
in this matter.