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  • Maxicare Franchisingform 2010

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    Jeff (OniokTV)
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    This document is a corporate account franchise form for Maxicare Healthcare Corporation. It collects information such as the franchisee details, corporate prospect entity, contact information, nature of business, number of enrollees and members, contract value, and remarks. It also outlines the franchise period dates including the effective date, expiry date, and details regarding extension requests. Signatures are included from the sales officer, verifiers, approvers, and those assigning the form.

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    maxicare_franchisingform_2010

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    This document is a corporate account franchise form for Maxicare Healthcare Corporation. It collects information such as the franchisee details, corporate prospect entity, contact information, nature of business, number of enrollees and members, contract value, and remarks. It also outlines the franchise period dates including the effective date, expiry date, and details regarding extension requests. Signatures are included from the sales officer, verifiers, approvers, and those assigning the form.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    5 views1 page

    Maxicare Franchisingform 2010

    Uploaded by

    Jeff (OniokTV)
    This document is a corporate account franchise form for Maxicare Healthcare Corporation. It collects information such as the franchisee details, corporate prospect entity, contact information, nature of business, number of enrollees and members, contract value, and remarks. It also outlines the franchise period dates including the effective date, expiry date, and details regarding extension requests. Signatures are included from the sales officer, verifiers, approvers, and those assigning the form.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
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    of 1

    CAFF july07

    MAXICARE HEALTHCARE CORPORATION


    CORPORATE ACCOUNT FRANCHISE FORM
    Franchise Request Date
    Sales Officer (Accredited Broker/Agent/CAO) Code

    Franchisee

    Corporate Prospect Entity

    Contact Person / Designation

    Address

    Contact Number(s)

    Nature of Business

    Existing HMO Expiry of Coverage


    Total Number of Principal
    Total Number of Enrollees Members

    Contract Value
    REMARKS:
    I agree and understand that this franchise is deemed expired on the date indicated and therefore open for awarding to other
    qualified applicants UNLESS renewed in writing through a LETTER OF EXTENSION received by Maxicare Healthcare
    Corporation five (5) days prior to expiration date.

    Conforme:

    Sales Officer (Accredited Broker /Agent /CAO)


    To be filled up by Maxicare
    Application Number
    Form Receipt Date
    REMARKS:

    FRANCHISE PERIOD

    Effective Date: Expiry Date:

    Date of Request for Extension: Extension Period:

    Verified by / Date:

    Approved by / Date:

    SM AVP

    Assigned to / Date:

    CAO SM

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