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Contact Information <br /> <br />*all documents must be returned: Master Service Agreement, Statement of Work, and Contact Information Sheet. <br /> <br /> <br />Organization URL <br />________________________________________________________________________________________________________________________ <br />Street Address <br />________________________________________________________________________________________________________________________ <br />Address 2 <br />________________________________________________________________________________________________________________________ <br />City State Postal Code <br />________________________________________________________________________________________________________________________ <br />CivicPlus provides telephone support for all trained clients from 7am –7pm Central Time, Monday-Friday (excluding holidays). <br />Emergency Support is provided on a 24/7/365 basis for representatives named by the Client. Client is responsible for <br />ensuring CivicPlus has current updates. <br />________________________________________________________________________________________________________________________ <br />Emergency Contact & Mobile Phone <br />________________________________________________________________________________________________________________________ <br />Emergency Contact & Mobile Phone <br />________________________________________________________________________________________________________________________ <br />Emergency Contact & Mobile Phone <br />________________________________________________________________________________________________________________________ <br />Billing Contact E-Mail <br />________________________________________________________________________________________________________________________ <br />Phone Ext. Fax <br />________________________________________________________________________________________________________________________ <br />Billing Address <br />________________________________________________________________________________________________________________________ <br />Address 2 <br />________________________________________________________________________________________________________________________ <br />City State Postal Code <br />________________________________________________________________________________________________________________________ <br />Tax ID # Sales Tax Exempt # <br />________________________________________________________________________________________________________________________ <br />Billing Terms Account Rep <br />________________________________________________________________________________________________________________________ <br />Info Required on Invoice (PO or Job #) <br />________________________________________________________________________________________________________________________ <br /> <br />Are you utilizing any external funding for your project (ex. FEMA, CARES): Y [ ] or N [ ] <br /> <br />Please list all external sources: _______________________________________________________________________________________________ <br /> <br />Contract Contact Email <br />________________________________________________________________________________________________________________________ <br />Phone Ext. Fax <br />________________________________________________________________________________________________________________________ <br />Project Contact Email <br />________________________________________________________________________________________________________________________ <br />Phone Ext. Fax <br />________________________________________________________________________________________________________________________ <br /> <br />V. PD 06.01.2015-0048 <br />Page 5 of 5