Laserfiche WebLink
APPLICATION NO. CONTRACT NO. <br /> mc1 rc ►® MAP Agreement 1026259 <br /> Meter Reading Contact Person <br /> -Managed Account ProgramPhone: :00 800.847.3013.— <br /> The <br /> i0 0: <br /> The words User,Lessee,you and your refer to Customer.The words Owner,Lessor,we,us and our refer to Marco,Inc. <br /> CUSTOMER •- • <br /> FULL LEGAL NAME OF CUSTOMER STREET ADDRESS <br /> Centerville, City of 1880 Main St <br /> CITY STATE ZIP PHONE FAX <br /> Centerville MN 55038 651-429-3232 <br /> BILLING NAME(IF DIFFERENT FROM ABOVE) BILLING STREET ADDRESS <br /> CITY STATE ZIP EMAIL <br /> EQUIPMENT LOCATION(IF DIFFERENT FROM ABOVE) <br /> EQUIPMENT • • <br /> Make/Model/Accessones Serial# Starting Meter Color Starling Meter B&W <br /> 1. KONICA BIZHUB C454E 45-PPM COLOR MFP <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Color Print Allowance 700 Excess Print Charge-Color* $0.048400 <br /> Minimum Payment*$ $296.23 B&W Print Allowance 4,000 Excess Print Charge-B&W* $0.007700 <br /> ,EQUIPMENT • • D. <br /> Make/Model/AccessonesSerial# Starting Meter B&W <br /> 1. <br /> 2. <br /> 3. <br /> 4. <br /> 5. <br /> Minimum Payment*$ B&W Print Allowance Excess Print Charge-B&W* <br /> `plus applicable taxes <br /> FREQUENCYOF ! <br /> Please Check One: Monthly Quarterly E Semi Annually DAnnually Please Check One.❑Monthly [�QuarterlySemi Annually OAnnually <br /> COVERAGETERM AND PAYMENT SCHEDULE SUPPLIES <br /> The contract payment("Minimum Payment') Please Check One.❑X All Inclusive IIUW Inclusive []No Supplies Included <br /> Term in Months 60 period is monthly unless otherwise indicated. (If none/s checked,no supplies will be Included) <br /> THIS IS A NONCANCELABLE/IRREVOCABLE AGREEMENT;THIS AGREEMENT CANNOT BE CANCELED OR TERMINATED. <br /> ,OWNER <br /> Marco,Inc. X <br /> OWNER SIGNATURE TITLE DATE <br /> PRIVACY AND INFORMATION <br /> You admowledge that the equipment you have moaved may be equipped with a hard dnve that may alone pemonal and confidential mlormaam(PCI)and you raiderstard the pmacy and inlomebm seasay,nsks associated win PCI that may be atoned on ypa Equipment Ya spree to be resporiade <br /> for safeguarding any PCI and you agree to indemnify and hold Manor,Inc hamilesa from any kis,nseppWmlion m breach of Me PCI that may be stored on your Equpnmt <br /> Centerville,City of X <br /> CUSTOMER(as referenced above) SIGNATURE TITLE DATE <br /> CUSTOMER <br /> 9y signing below,you oabfy to Owner that you hm recaved,mad,and Was to all lems and co iNions on tens page and—m second of ahs fai Agreement <br /> Centerville,City of X <br /> CUSTOMER(as referenced above) SIGNATURE TITLE DATE <br /> FEDERAL TAX I.D.# PRINT NAME <br /> ACCEPTANCE OF <br /> You certify,that all the Equipment hated above has been received,installed,inspected,and x fully operational and urrcorMdionally accepted <br /> Centerville,City of X <br /> CUSTOMER(as referenced above) SIGNATURE TITLE DATE OF DELIVERY <br /> 29683(2012 v1)-4 23 14 Page 1 of 2 V6 8 <br /> 36 <br />