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<br />Rental Account #
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<br />ORDER # C08t.j 5;;;? /'
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<br />BILLING ADDRESS CI'TY STATE
<br />ZIP+4 SEN~eO ATTN OF
<br />EQUIPMENT LOCATION IF NOT SAME AS ABOV CI'TY STATE ZIP+4
<br />CREDIT CARD # EXP DATE NAME ON CARD 'TYPE
<br />TAX EXEMPT #
<br />FISCAL PERIOD FROM TO RENTER PO #
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<br />Your Business Needs
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<br />CHECK ITEMS TO BE INCLUDED IN YOUR PERIOD PAYMENT
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<br />o Equipment Maintenance Agreement On Rental
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<br />Initial Rental TelJP:
<br />Frequency f/1Vlonthly [J Quarterly [J Other (specify_'_.,_)
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<br />II First b ~~_.,
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<br />Next
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<br />months IE () per month
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<br />months ~. per month
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<br />Initial Clleck Amount
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<br />._ 0 Soft-Guard Agreement
<br />.tJ Software Maintenance Agreement
<br />[J Meter On Rental
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<br />By your signature as "Rentor' below, you request Ihat we rent 10 you the equipment described above or on allY SCilGdule
<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 Sclledule, subject to the terms and cOlldiliens 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 tile Payment Schedule other than the "Final 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,
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<br />1. NON-APPROPRIATION. You warrant that you Ilave 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 />periOlJ threugh tile end of your Initial Term, If your appropriation request to yeur legislative bOlly, or rllllding uutllCnty
<br />("Governing Body") for funds to pay the Totai Payments is denied, you may terminate this Agreement on the last day of the
<br />fiscal period for which funds have been appropriated, upon (i) submission of documentation reasonably satisfactory to !IS
<br />evidencing the Governing Body's denial of an appropriation sufficient to continue this Agreement for tile next succeeding
<br />fiscal period, and (Ii) 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, , ,
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<br />DATE
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<br />DISTRICT NAME & if
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<br />PB i1,CCEPTED BY,_______________JiTL~_,____
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<br />DATE
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<br />EXECUTIVE OFFICE: 27 WilT::R\fIEW DR " SHELTml. CT O['H84-4361 .. EOUIP,viENT VENDOR: PITNEY BOWES, !~jC, -) FOR SALES AND SERVICE CALL 1-800-322-8000
<br />INlEt COP',! ?8C2' PiN:< COPY PITNEY BOWES INC, ,) YELLOW COpy CUSTOiV!EFi
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