altnagelvin hospital ward map

Trust: Western Health and Social Care Trust. We will consider your feedback to help improve the site. Altnagelvin Hospital Fracture Clinic :( :(, Real Estate Agent - Entle Somdaka - Fraud agents. NjgwNTczZTE5ZTFlYWE2OTUyY2U0ZGMzZmQ5ZTQ0NTA2OGVjMDEzMTdjMmQy If you wish to make a donation to us we will add this to the donation which we will pass on to the Riding for the Disabled Association. Call 0800 587 0912 ZDAwYTA1NjdjMTU3NzNhMWFmNzIwZGM5ZWQ3YTE4MzZlYTc0NDlkZGE3YzQ5 Ward C3 Access Guide, C4 Surgical Tel: 028 9442 4186 The area of the region le-de-France is 12 012,27 km . If you wish to report a problem with a road or street you can do so online in this section. NzJlNzVlOTExMTVkMzc1OThjNTM5NjJiY2Q0YTBiZTdlN2UzYTkwMWZmZGNi Ward A6 Access Guide, Outpatients 4 Tel: 028 9442 4000 Create a website or blog at WordPress.com, Queenu0026#8217;s Award for Voluntaryu0026nbsp;Service, Friends of Altnagelvin Hospitalu0026nbsp;Choir. Mapcarta, the open map. A Reset font size. A Decrease font size. If you wish to check on a problem or fault you have already reported, contact DfI Roads. Share on Facebook (external link opens in a new window / tab), Share on Twitter (external link opens in a new window / tab), Share by email (external link opens in a new window / tab), Which problem did you find on this page? Keep an eye on this spot and our EVENTS page. There have been 3,161 confirmed. altnagelvin hospital ward map. The Company Hair Salon - Highly Recommend! . Sean Gibson, head of estate management at the Western Health Trust,. These are some of the main hospitals / departments of neuroscience in Ireland / Northern Ireland, along with a few significant ones from farther afield. The main hospital building consists of a tower block with a number of adjoining new extensions accommodating the outpatients department, day case unit, medical imaging, theatres, surgical wards, maternity ward, oncology unit, physiotherapy department. The IICN supports and facilitates research in clinical neuroscience in Ireland. For queries or advice about criminal record checks, email ani@accessni.gov.uk, Application and payment queries can be emailed toema_ni@slc.co.uk. Public Transport Address Altnagelvin Hospital Glenshane Road Londonderry BT47 6SB Telephone 028 7134 5171 View the Altnagelvin Hospital website Find other facilities close to Altnagelvin Hospital, Londonderry + Leaflet OpenStreetMap contributors Ward C5 Access Guide, C7 Renal/Haematology Contact switchboard on 02894424000 ZTM4MjRmMzU5MDQ0ZGE1MTZjNWQxYzQ1NTUxOTg2MDQ2YTJmIiwic2lnbmF0 In a video posted on social media. Europe. Eighteen staff members from a ward at Altnagelvin Hospital in Londonderry are currently off work as a result of a Covid-19 outbreak. / 54.985; -7.295. Northern Ireland, Londonderry, Altnagelvin Area Hospital - Coronary Care Unit - Ward 44. For queries or advice about Child Maintenance, contact the Child Maintenance Service. - health and social care providers Altnagelvin Hospital has temporarily closed Ward 20 to new admissions. For queries about your identity check, email nida@nidirect.gov.uk. 2 buyers. Altnagelvin Area Hospital is an acute hospital which offers a range of services, including a 24-hour Accident and Emergency Department and is one of Northern Ireland's five designated cancer units. NDQzYzI2NDU5NmI1ZjM1NGJiMTk1OGRiYTk5YTQwMjEyOGJkODg0MjdjMWEz ODQ3YzU0YjcxZjllY2QxZjNmNzgzNDQ0NGQ2MzVhNDk2ZTdmZDY0ZjBiOWY0 : *. Proud of our founding and enduring association with Altnagelvin Hospital, the first general hospital to be built in the UK following the foundation of the NHS, we perform two main fundraising concerts per year to support localand national charities which have a focus on health and / or social well-being. Ward C1 Access Guide, C2 Maternity Tel: 28 9442 4495 Altnagelvin Area Hospital - Coronary Care Unit - Ward 44 - Londonderry - WorldPlaces Click here to show the map Altnagelvin Area Hospital - Coronary Care Unit - Ward 44 GPS Coordinates 54.98546,-7.29171 Suggest Information Update Submit Review Ask a Question Map View at Instagram Report this page Questions about this place B5 Short Stay Ward - Tel: 028 9442 4000. ZTk2MDU1ZGFjNmI4ZjQ2Nzc1MTMwZDI3NjY1OTg3ODJmZDRkYzdiM2QyMTk1 Comments or queries about the Blue Badge scheme can be emailed to bluebadges@infrastructure-ni.gov.uk or you can also call 0300 200 7818. It has 472 inpatient beds and 36 day case beds. Bretten Hall, This is building 13 on the map below. The Regulation and Quality Improvement Authority (RQIA) is the independent body responsible for monitoring and inspecting the availability and quality of health and social care services in Northern Ireland, and encouraging improvements in the quality of those services. 1. Glenshane Road If you know the ward or department you need to speak to, please refer to the numbers listed below. Proud of our founding and enduring association with Altnagelvin Hospital, the first general hospital to be built in the UK following the foundation of the NHS, we perform two main fundraising concerts per year to support local and national charities which have a focus on health and / or social well-being. This was in place of the usual, annual, in-person remembrance service for family members and was incorporated into a video along with readings and prayers by the Hospital Chaplaincy Team. Altnagelvin Hospital Fracture Clinic :( :(, Real Estate Agent - Entle Somdaka - Fraud agents. A user guide for the system is available below: Unauthorised access to this system is strictly forbidden. Posted. Contacts for common benefits are listed below. We sing at the Altnagelvin Hospital ICU Memorial Service in November each year and sing carols on the wards after our main Christmas concert. ZTI1YjM3NTdiZGEzNTJjMWI0YWI3NDZhNTYzODRjMWUyZjUwNDM1ODViNjJh A Increase font size. It provides services to the city of Derry and County Londonderry, but also some specialist and acute services for parts of neighbouring County Donegal, County . 14 October 2020 14 Oct 2020. For queries or advice about Penalty Charge Notices (PCNs), including parking tickets and bus lane PCNs, emaildcu@infrastructure-ni.gov.uk. It was made for Altnagelvin ICU A Time to Remember Service video 2021 and recorded in Christ Church. For queries or advice about 60+ and Senior Citizen SmartPasses (which can be used to get concessionary travel on public transport), contactSmartpass - Translink. Londonderry northern ireland assembly. . The Organist was Nicky Morton and it was conducted by our Musical Director, Derek Collins. The page you requested could not be found. We sing in four parts and our ever-growing repertoire includes choral music from the last five centuries. Full-month calendar of IICN-noted events. Altnagelvin Hospital Helipad, 410 feet southwest; Accident and Emergency Department Clinic, 420 feet west; Outpatients Clinic, 540 feet west; Popular . 54.98546,-7.29171, by Anonymous The region of le-de-France has the number 11. United Kingdom, Emergency Department - open 24 hours every day. If you believe Wordfence should be allowing you access to this site, please let them know using the steps below so they can investigate why this is happening. (Tick all that apply), dcs.incomingpostteamdhc2@nissa.gsi.gov.uk, customerservice.unit@communities-ni.gov.uk, Driver and Vehicle Licensing Agency (DVLA), Swansea, Driver & Vehicle Agency (DVA), Northern Ireland, Public Record Office of Northern Ireland (PRONI) enquiry service, contact the relevant government organisation directly, Travel advice (including self-isolation), Coronavirus (COVID-19) vaccinations contact the, Driver licensing and tests, MOT and vehicle testing. These are some of the main international neuroscience-related organisations. Altnagelvin Area Hospital Glenshane Road Londonderry BT47 6SB United Kingdom Phone 028 7134 5171 Opening hours Emergency Department - open 24 hours every day Location Share this page How to. Part of Altnagelvin hospital in Londonderry is evacuated after smoke was discovered in one of the wards. Some of the main Neuroscience-related agencies, Europe, Some of the main Neuroscience-related agencies, Ireland, Some of the main Neuroscience-related agencies, World. You must have JavaScript enabled to use this form. Stay up to date with meetings and conferences (online and offline) of relevance to neurologists and other neuroscientists. Ward B1 Access Guide, B2 General Tel: 28 9442 4706 - a new build 2 storey extension to create a direct link . Ward B5 Access Guide, Pre Op Assessment Unit Tel: 028 9442 49962, Pre Op Assessment Unit Access Guide, Radiology Department Tel: 028 9442 4517 1 year ago, What is ward 44 direct line telephone number, 15-19 Spencer Road, Waterside, Londonderry, 74 Victoria Gate, Victoria Road, Derry City. Altnagelvin Area Hospital is the main hospital for the North West of Northern Ireland. This mod allows you to combine the le-de-France (Paris suburbs) map with the Paris 1:1 map from fisherm to allow longer rides in the le-de-France region. MmYyMzQ5NGIzNzVkNGRjY2I0NzQ5ZjlmMGM1Zjg1NDE5NTk5MjQyNDhjZGVk They allow assessments for coronavirus to be moved away from normal GP practices. The Altnagelvin centre is one of the first to open in Northern Ireland. Legal Entity: *CorporationLLCSole Proprietorship. Again, there remains restrictions on certain ward areas due to covid but there has been significant progress. Aubaine Eyecare Inc. +2348033403334 - A great place to have a comprehensive eye exams. NDRiOGFkZjI3M2U0MzI4N2ZhYzc2MGVhMWI2OWVjYWQ4ZWVhMzRjMmQ0M2Uz When and where do you rehearse? Outpatients 6 Access Guide, Finance Department/Cash Office Tel: 028 9442 4000 Altnagelvin Hospital is a hospital in Northern Ireland located on Glenshane Road. Altnagelvin assaults: Man fails to have sentence reduced 30 June 2017 McConnell has 18 previous convictions, several of them for assaults A 60-year-old man who assaulted a ward sister, a nurse. BT47 6SB Doctor360 does not accept, endorse, or promote health practitioners including, the content of any profiles nor the comments or discussions in the community forum. You are here: Home 1 / Clearway in the Community 2 / Uncategorised 3 / what is ward 25 altnagelvin hospital. Courtney Jade Makeup & Brow Boutique - Best Place for Free Brows. ZmVhMGZmMmU5MTBkMzAwMTU1MDM5MzRhYzJjYmViMTkyNGVkZDE2NWZlYTZl The North Wing facility will provide an additional six new 24 bed inpatient ward areas and a new main entrance to Altnagelvin Hospital. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our efforts. A copy of this authorization may be accepted as an original. Altnagelvin Area Hospital. This is a recording of Gaelic Blessing by John Rutter and Irish Blessing, by Philip Stopford. by | Jun 10, 2022 | total number of judge positions appointed by the president | how to pick lock in cold war campaign | Jun 10, 2022 | total number of judge positions appointed by the president | how to pick lock in cold war campaign To register with the NIMDTA Course Booking System, please click on Register. Foyle & West. T: +44 (0)28 9055 1300 www.farrans.com TAGS Altnagelvin Hospital CB Contracts Construction Specialties Elite Doors farrens Fire Protec Fireglass Direct For queries about your identity check, email nida@nidirect.gov.uk and for queries about your certificate, email covidcertni@hscni.net. Northern Ireland. Our ICT department are now working on getting the full system installed and operational across all wards. MDU1ZTYxOWQ2ZTVlYjVhMjM0YWI5OGJiNmUzMDJiYjQ3ZmY0ZDQ5ZDA0NzAz For queries or advice about pensions, contact theNorthern Ireland Pension Centre. All six ward areas are now operational and the Trust is . -----END REPORT-----. Antrim, Fast & Free. When we ask the Department about the blood-transfusion service, officials say that it is in place. Altnagelvin Radiotherapy Unit, Londonderry Construction Client WHSCT Value 31,500,000 Architect O'Connell Mahon Architects Construction of a new Radiotherapy Unit on a brownfield site within a live hospital campus. - School fee. The scheduled Friday morning Neuroscience Conference is now accessible to IICN Members and neuroscience trainees via WebEx. Ward A4 Access Guide, Ward A6 Medical Tel: 028 9442 4000 Altnagelvin Hospital (Image: Justin Kernoghan / BelfastLive) The Western Trust has increased the number of people allowed to visit their loved ones in hospitals. Our locationNew York, NY 10010 Call us(917) 636-4420. declaration of non responsibility kirkland; micah taylor detroit; hud fivem esx Geochart for 2 buyers and 0 suppliers . Tel: 028 7134 5171. Our reviews aim to encourage continuous improvements in health and social care services and ensure the rights of service users are safeguarded. Under the Health and Social Care (Reform) Act (NI) 2009, RQIA undertakes a range of responsibilities for people with a mental illness and those with a learning disability. The presentation was made in memory of Anne Relf who was treated on the ward. A patient who waited four days for a bed at Altnagelvin Hospital's Emergency Department (ED) has now been admitted to a ward, the Western Trust has said. Ward A1 Access Guide, A2 Paediatric Tel: 028 9442 4266 Renal Unit - Tel: 028 . As well as our two main concerts, we also provide a number of community service events. Your access to this site was blocked by Wordfence, a security provider, who protects sites from malicious activity. email us using this address: AltnagelvinHospitalChoir@gmail.com; use Contact Us button on this site or our Facebook Page . Contact us and we'll get back to you with your query. Tuesday 15 April 2008. Access a wide range of medical journals via this members-only page. These are all signposted throughout the site. If Yes, what is the Current Outstanding Balance? A1 Medical Tel: 28 9442 4905 CPD Health Projects Belfast ; . Glenshane Road,Londonderry BT47 6SB Click for Map. The Derry City and Strabane District Council area has the highest infection rate in Northern Ireland. Individual members will want to raise points about the disturbing issue of X-rays at Altnagelvin Area Hospital and all the issues . Radiology Department Access Guide, Renal Unit Tel: 028 9442 4472 The Charity is active locally and across the UK. MDZmMGU4ZTAyNWY1MGEzNDdhZWE5ODM3M2E1ZjkzMzg4NTE0MmU1MGY2ZmEz Disclaimer : Prices & availability of services & treatments are subject to change, please call healthcare practitioner directly for any information. For queries or advice about claiming compensation due to a road problem, contact DFI Roads claim unit. If your query is about another benefit, select Other from the drop-down menu above. Application for membership of the IICN is open to medical doctors who practise in the neuroscience disciplines. We can also be found on Facebook,Twitterand Instagram. Emaildcs.incomingpostteamdhc2@nissa.gsi.gov.uk, Call 0800 587 2750 Map Altnagelvin Hospital Altnagelvin Hospital Name: Altnagelvin Hospital Address: MDEC Building, Londonderry,BT47 6SB Manager Name: Telephone: 028 7134 5171 Care Service Type: Hospital Categories of Care: No Categories available List of Inspection Reports: 29 May 2019 - Hygiene 27 September 2018 - Care 3 May 2018 - Hygiene 14 June 2017 - Augmented Altnagelvin - Curryneirin - Ardground 4b City Centre . M2ZkNWM2Yjg0YzhhYWI2NDFhMDI4MWU3YzVmOTc1MWJhYTAwYjYwNDRiYTlj While we take the music seriously, we enjoy the social and shared aspect of our work together. OGNlYmVjYTk4MWEzNjIwNGVjYzMwZTQyMzI5MzkxNTA0YWE1NzM3NmZiZTBj James House, 2-4 Cromac Avenue, BELFAST, BT7 2JA, RQIA, James House, 2-4 Cromac Avenue, Belfast, BT7 2JA / Email: info@rqia.org.uk, The Regulation and Quality Improvement Authority, Mental Health & Learning Disability Services, Remedy Deficiencies in Care & Treatment Hospitals, Appointment of Second Opinion Appointed Doctors (SOADs), Neurology: Outpatient Services in Belfast Trust (focusing on Neurology & High Volume Specialties), Neurology: Independent (Private) Hospitals and Hospices in Northern Ireland, Expert Review of Records of Patients of Dr Watt who died 2008-18, RQIA Events / Training for Service Providers, Standards for Employers of Social Workers & Social Care Workers, Frequently Asked Questions for Service Providers, Ionising Radiation (Medical Exposure) Regulations (IR(ME)R), A Review of the Effectiveness of the Use of CCTV in Care Home Settings, Freedom of Information (FOI) & Data Protection. Emergency Department Access Guide, B1 Admission Tel: 028 9442 4505 This section of the site will be available shortly. Altnagelvin Area Hospital. The Company Hair Salon - Highly Recommend! Ward C2 Access Guide, Delivery Suite Tel: 028 9442 4167 ZjlkMDZhYjU4YzViZWFlN2RkMjYwZDY4OGQ4YjU1ODM1NDMyZGYxMmNiMDg5 Our inspectors visit nursing and residential care homes and children's homes to examine all aspects of the care provided, to guarantee the comfort and dignity of those using the facilities, and ensure public confidence in these services. MmUyYWM1YTI0MTRjMGM5MTRjOGZkODkwZmRkMzM1MjViYjM4YmQyZDVhNjJh You can reach them on 028 7134 5171. NmVlOTdiNTFlNDIxYzllZGUxOTMwYTQifQ== Altnagelvin Hospital is situated nearby to Waterside Police Station and Glendermot Church of Ireland. Britain and Ireland. If you do not receive an email containing your login details please check your JUNK EMAIL folder as it may be mistaken for SPAM. OGM4N2ZmNmUyOGM5MjllNjJjZTVhNjM5MDlhMjcxYWMzZGVmZTg3Mzg1ZTQ1 YjZhZjI0N2FlOWJhYTljN2U3ZTMwMGZlYTRlNzEyZTQ1YWI0YjE0MTA1ODRh Please leave this field empty. RQIA inspects a range of health and social care services. Mjc2MjY3ZDhlYzg1MTcwZTQzM2Q2NTJhNmYyZjAzMzJmNGRlMWM0OTkyOWYx ZmQxZTIwZTJiYjY4MjhhZjExNjNjMzEyMzg4MDFlM2IzMGE1MDBiOTM3NGIy The Western Health Trust has confirmed to the BBC that. South Wing is situated nearby to Altnagelvin Hospital and Glendermot Church of Ireland. THE Western Trust has announced that Altnagelvin Hospital in Derry is moving to '1-1-1' visiting restrictions, (one visitor per patient for one hour, once a day). Welcome to Ward 40 (February 2019) www.uhcw.nhs.uk -3 Contact details Ward 40: Area1: 024 7696 8328 Ward Manager: Abel Lim Area 2: 024 7696 8326 Area 3: 024 7696 8324 Area 4: 024 7696 8329 We appreciate your feedback and comments; if you would like to provide us with Two at the South West Acute Hospital [Emergency Surgical Ward 8 has 22 beds / Ward 9 is an Elective Surgical Ward with 18 funded beds Monday to Friday and 12 funded beds at the weekends]. Dr Herron added that "it became very. Click any item above to reach the corresponding page with fuller options and information. Emailcustomerservice.unit@communities-ni.gov.uk, Call 0800 587 0912Email dcs.incomingpostteamdhc2@nissa.gsi.gov.uk, Contact your local Jobs & Benefits office. NDRkZWY0MDY5OGQ5N2RhMzRmYjIzN2M0ZGM1YjFiMDUxZjA5NmI3ZjZjZjUw For queries about the High Street Spend Local Scheme, emailHSSS.mail@economy-ni.gov.uk. Eighteen staff members from a ward at Altnagelvin Hospital in Londonderry are currently off work as a result of a Covid-19 outbreak. - members of the public South Wing South Wing is a . altnagelvin hospital ward mapshaun thompson elmhurst Consultation Request a Free Consultation Now. The Western Health and Social Care Trust has announced that '1-1-1' visiting restrictions, (one visitor per patient for one hour, once a day), will now apply to all Western Trust facilities, with the exception of Altnagelvin Hospital, which will continue to restrict visitors to once a week (in most circumstances). NzgzMTg2OGIwNjIzY2VmMDJhMWYyMGM5YzE5Njg1ZmE4NDc4MzQxYWY3MTQ3 N2M4NTNkNzM4ZjhiYTIyMzVjMzMyMGQyZTc5NTA4ZThhZTk5M2U4ZjUyMDhm BT41 2RL. Radiology Department - Tel: 028 9442 4517. Visits suspended at Altnagelvin Hospital. ), I certify that the information entered is my own and accurate to the best of my knowledge. ZjJjNGNlNzhiYzE3YzRjODc1Yzg3NmM5YzgwY2UyMDBmM2M1YTUyMjZhYWIy Altnagelvin Hospital is a Hospital facility based in Londonderry. YmFhOTRlMWEyNmZmOTI4NzU3NTkxZTEyNWE3NzVmY2M3ZWNjMGM0NTczODBm dXJlIjoiOGRlZGMyY2YxZDdiMDJkNWRmMGVlZWI5MTAwYzQwZDE3ZWZjMGNh Ward 3 - Respiratory Medicine. - School fee. Whatever your voice (Soprano, Alto, Tenor and Bass), if you are interested in exploring what we do, Contact Us. Ward C4 Access Guide, C5 Gastroenterology Tel: 028 9442 4989 Applications are invited for Research and Education grants which are supported by the IICN , as funding is available. UK. Please enable cookies before proceeding with a booking to ensure payments can be processed. Altnagelvin Hospital. Stay up to date with research opportunities of relevance to neurologists and other neuroscientists. Altnagelvin Area Hospitalis an acute hospital which offers a range of services, including a 24-hour Accident and Emergency Department and is one of Northern Irelands five designated cancer units. You can do this by emailing us for our bank details for a bank transfer, for our Treasurers address to send a cheque or via Pay Pal as below. If youre unsure which department you need, the main switchboard will be able to direct your call on 028 9442 4000. YjM2ZTlmOWYyMTNmMTQ1MTcyZWY2YTdhNjdhNGNhMTI3MTc4ZWRmNGMwMmI3 MTZjMmExYmU4ZmJjMGE4NzU3ZDI4ZTFkNjlhYjNiMmU5MjdmZDI1YjgxMzBm Rhino Rocker Panel Restoration - Professional and Affordable, Neo Black Movement Of Africa AKA Black Axe - N B M, - , ENB Savings and Loans Society - Car loan,interest and repayment, TWINS Garden - Number of rooms, meeting rooms, size of venue, style of venue and participants, Promised Land Secondary School. / 54.985; -7.295. Inhabitants of le-de-France were 10 952 011 in 1999 and 11 532 398 in 2006. If you cant find the information youre looking for in theCoronavirus (COVID-19) section, then for queries about: If your query is about another topic, select Other from the drop-down menu above. Outpatients 1 and 2 Access Guide, Childrens Ambulatory Unit Tel: 28 9442 4000 We provide compassionate care with our community, in our community. The dignity shown to all patients whether on the Covid-19 ward, in the Emergency Department or in ICU was striking These same people, almost 12 months ago, were preparing for strike action. A third ward has been identified for further admissions, the trust said. This addition has taken a disparate set of buildings, including a newly completed Cancer Centre and a 1960s tower block, and deftly tied them together. The main hospital building consists of a tower block with a number of adjoining new extensions accommodating the outpatients department, day case unit, medical imaging, theatres, surgical wards, maternity ward, oncology unit, physiotherapy department. A funeral service will take place in his late home 80 Primity Crescent, Newbuildings, on Wednesday 1st March 2023 at 12 noon, followed by burial in Altnagelvin Cemetery. We will also sing more Christmas themed music and congregational carols. what is ward 25 altnagelvin hospital 12th June 2022 . You can access a range of guidance documents and frequently asked questions in this section of the website. 54.98562,-7.29211, 15-19 Spencer Road, Waterside, Londonderry, 74 Victoria Gate, Victoria Road, Derry City. RQIA also has a role in assuring the quality of services provided by Health and Social Care (HSC) Board, HSC trusts agencies, to ensure that every aspect of care reached the standards laid down by the Department of Health, and expected by the public. MjJiMTA2NGY5MDlhMzBjODIxODM3MThjZmFjMGQwODhlNzgzNzRiMTkyOWU0 MjQ1ZDhhMThhNWQ2MGQ1YTdmMjM5OWY2NmJhYjlhMWFlZTkxYWNkOWY5NTBi There are also separate buildings such as the Renal Unit, Spruce House, Anderson House, Breast Screening Unit and the laboratories and pharmacy building. Altnagelvin Area Hospital in Londonderry, Londonderry BT47 6SB - Doctor360 Procedures Best Offers Buy Lab Tests & Scans Prices Get a Quote UNVERIFIED Altnagelvin Area Hospital General Hospital Glenshane Road, Londonderry, BT476SB View Phone Number General Hospitals in Londonderry Overview Facilities Hours Price Speciality Contact Reviews Total Monthly Sales (All Forms of Revenue): *, Gross Annual Sales (Last Years Tax Return): *, Do you currently have a Cash Advance? NjcyMTNhMDk1OWQzOTMxZTI1ZjJkM2E4MjU5M2QyMWZlMDI4NWQ3ZmI4ZTZl GPS Coordinates NWViNWIyYjhiMTczZTlmOGY1MmE2OTU2Y2QyZjZhMWUzNGQ0NDBmMjVmMzlm Visiting had been suspended at. The Merchant and Owner(s)/Officer(s) identified above (individually, an Applicant) each represents, acknowledges and agrees that (1) all information and documents provided to Representative including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify Representative of any change in such information or financial condition, (3) Applicant authorizes Representative to disclose all information and documents that Representative may obtain including credit reports to other persons or entities (collectively, Assignees) that may be involved with or acquire commercial loans having daily repayment features or purchases of future receivables including Merchant Cash Advance transactions, including without limitation the application therefor (collectively, Transactions), and each Assignee is authorized to use such information and documents, and share such information and documents with other Assignees, in connection with potential Transactions, (4) Representative and each Assignee will rely upon the accuracy and completeness of such information and documents, (5) Representative, Assignees, and each of their representatives, successors, assigns and designees (collectively, Recipients) are authorized to request and receive any investigative reports, credit reports, statements from creditors or financial institutions, verification of information, or any other information that a Recipient deems necessary, (6) Applicant waives and releases any claims against Recipients and any informationproviders arising from any act or omission relating to the requesting, receiving or release of information, and (7) each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant.

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