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<br />-f/~Je- /or2 <br />~ p.t . B · <br />=rnn= I ney owes <br /> <br />~ <br /> <br />STATE AND LOCAL GOVERNMENT TERM RENTAL AGREEMENT I <br /> <br />~ <br /> <br />Your Business Infonnation <br /> <br />CAN # <br /> <br />ORDER # <br /> <br /> <br />DBA NAME <br /> <br />ZIP+4 <br /> <br /> <br />CITY <br /> <br />EQUIPMENT LOCATION IF NOT SAME AS ABO <br /> <br />CREDIT CARD # <br /> <br />--r <br /> <br />EXPDATE <br /> <br />NAME ON CARD <br /> <br />TYPE <br /> <br />TAX EXEMPT # <br /> <br /> <br />FISCAL PERIOD FROM <br /> <br />TO <br /> <br />RENTER PO # <br /> <br />~ <br /> <br />Your Business Needs <br /> <br />CWC7~i. ,,~itJ:i!rent & .s:eniices Description Equipment DescrIption (New. R~. Demo, Newiy Remanufactured) <br />,.\ '.,' '.t..r, <br /> <br /> <br />- - <br />/ VY'I VI ...l <br /> <br />CHECK ITEMS TO BE INCLUDED IN YOUR PERIOD PAYMENT <br />t& Equipment Maintenance Agreement On Rental <br /> <br />o Soft-Guard Agreement <br />;31 Software Maintenance Agreement <br />o Meter On Rental <br /> <br />~.. <br />:;::::::;\ <br />~~...... <br /> <br />Payment Schedule I Billing <br /> <br /> <br />~ Your Payment Plan <br /> <br />Initial Rental Term: S7 <br />Frequency 0 Monthly 0 Quarterly 0 Other (specify ) <br /> <br />Rrst S months $ O()per monlh <br /> <br />Next months $ per monlh <br /> <br />Next monlhs $ per monlh <br /> <br />Rnal Payment $ 100.00 <br /> <br />;y/;'.~~ <br />r <br />~ Rental Tenns and Conditions <br /> <br />Initial Check Amount <br />SIGNATURE ')(. <br />PRINT NAME <br />PB ACCOUNT REP NAME <br /> <br />$ <br /> <br />By your signature as "Renter" below, you request that we rent to you the equipment described above or on any schedule <br />attached hereto (the "Equipment") for essential govemmental purposes in consideration of your payment to us of the amounts <br />set forth in the Payment Schedule, subject to the terms and conditions provided in this Agreement. For purposes of this <br />Agreement, all payments set forth in the Payment Schedule shall be referred to as the "Total Payments," The payments <br />referred to in the Payment Schedule other than the "Rnal Payment" shall be referred to singularly as a "Period Payment" <br />and collectively as the "Period Payments." Your offer will be binding on us when we accept it by having an authorized <br />employee sign it. All payments hereunder shall be payable only to us at our executive offices unless we direct you <br />otherwise in writing. <br /> <br />1. NON,APPROPRIATlON. You warrant that you have funds available to pay the Total Payments until the end of your <br />current fiscal period, and shall use your best efforts to obtain funds to pay the Total Payments in each subsequent fiscal <br />periOd through the end of your Initial Term, n your appropriation request to your legislative body, or funding authority <br />("Goveming Body") for funds to pay the Total Payments is denied, you may terminate this Agreement on the last day of the <br />fiscal period for which funds have been appropriated, upon 0) submission of documentation reasonably satisfactory to us <br />evidencing the Governing Body's denial of an appropriation sufficient to continue this Agreement for the next succeeding <br />fiscal pe-Hod, and on satisfaction of all charges and obligations under this Agreement incurred through the end of the fiscal <br />periOd for which funds have been appropriated, including the return of the Equipment at your expense. <br /> <br />TITLE <br /> <br /> <br /> <br />DATE <br /> <br />EMPLOYEE # <br /> <br />DISTRICT NAME & # <br /> <br />PB ACCEPTED BY TITLE DATE <br /> <br />EXECUTIVE OFRCE: 27 WATERVlEW DR · SHELTON, CT 06484-4361 · EQUIPMENT VENDOR: PITNEY BOWES, INC. . FOR SALES AND SERVICE CALL 1-800-322-8000 <br />WHITE COPY PBCC · PINK COpy PITNEY BOWES INC. · YELLOW COpy CUSTOMER <br />PAGE 1 <br />PB SLR2 (8/01) ~~~ Pllr.:~ ? mR IInnITI(l~11I1 T~RM~ 1I~ln r.mInITI(lN~ <br />