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<br />,eve ,3-0 r ;z <br />~. - -A- <br />=rnFr= Pitney B~s <br /> <br />BILLING ADDRESS <br /> <br /> <br />: I <br />STATE AND LOCAL GOVERNMENT TERM RENTAL AGREEMENTI <br /> <br />Rental Account # <br /> <br />CAN # <br /> <br />ORDER # <br /> <br />ZIP+4 <br /> <br />EQUIPMENT LOCATION IF NOT SAME AS ABO <br /> <br />CREDIT CARD # <br /> <br />-?- <br /> <br />EXP DATE <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 />Qty Model Equipment & Sentices DescriptiOn E~ Qesqiption ~ Aecoi1ditiOOed, Demo, Nwdy Aemllr1Ufac/ured <br /> <br />CHECK ITEMS TO BE INCLUDED IN YOUR PERIOD PAYMENT <br /> <br /> <br />-j([,Equlpment Maintenance Agreement On Rental <br />o Soft-Guard Agreement <br /> <br />~oflware Maintenance Agreement <br />o Meter On Rental <br /> <br />~\\ <br />~~ <br /> <br />(I <br /> <br />Payment Schedule I Billing <br /> <br /> <br />~ Your Payment Plan <br /> <br />Initial Rental Term: <br />Frequency 0 Monthly 0 Quarterly 0 Other (specify <br /> <br />~ Rental TenDS and Conditions <br /> <br />First mon1t1s $ per mon1t1 <br />Next mon1t1s $ per mon1t1 <br />Next mon1t1s $ per month <br />Final Payment $ 100.00 <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 governmental 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 lhis 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 af 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 Tenn. If your appropriation request to your legislative body, or funding authority <br />("Governing 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 (ij 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 pl!{iod, and QQ 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 />Inilial Check Amount <br /> <br />$ <br /> <br />SIGNATURE <br /> <br />PRINT NAME <br />PB ACCOUNT REP NAME <br /> <br />EMPLOYEE # <br /> <br />TITLE <br />DATE <br />DISTRICT NAME & # <br /> <br />PB ACCEPTED BY TITLE DATE <br /> <br />EXECUTIVE OFFICE' 27 WATERVIEW 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) SEE PAGE 2 FOR ADDITIONAL TERMS AND CONDITIONS [ <br />