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r . ? <br />140 N Mitcheli Ct„ Suite 200 <br />Addison, 1L 60101-5629 <br />7e1: (800) 341-6052 <br />ICOTYP-POSTALIA Fax: (800) 810-3768 <br />ffral?lll www.fp-usa.com <br />Customer Information <br />Ren#al Agreement <br />LJ New Customer ? Renewal <br />? Change of Ownership <br />? Upgrade from <br />? Lease Company <br />Billing Address <br /> <br />Customer. / <br />Department: ? <br />Street: <br />City: County: <br />State: Zip: <br />Tel: Fax= <br />Email: Contact Name: <br />Tax ID: <br />? Tau Exempt certificate attached <br />Monthly Rental Payment Terms <br />Account h <br />Contract t <br />Promo Co <br />ShippingJ Installation Acldress <br /> <br />Customer. L._?'?,? , ? <br />?Z,-L„x-F,?-- <br />,a <br />Department: <br /> <br />Street: i ? <br />C <br /> <br />? <br />City: <br />•? <br /> <br />CountY; Z? <br />State: Zip: <br />- - <br />Tel. <br />Fax:?:=?/ <br />Email: • <br />I Contact Name: VN ??c,, Y) L Li r`Dii Iw('-l <br /> ,. <br />ment <br />Meter &'?gui <br />i <br />? <br />MonthlyrRate <br />'ta'Biil rr x? ?r,'"?`Fn?.rt or?? ?,; <br />n• <br />4 , <br />' }j??,?~Eie <br />? <br />;}(?uantity ? , , <br />p <br />,? <br />Y +S ? <br />7 <br />t <br />c t?,;. ? '•S 'nvkv+ <br />..a.?'w' r.k- <br />t?m? <br />?kl+?i}si <br />A ?N <br />4' <br />t? <br />? <br />i: <br />f:.. _ <br />'I.? <br />?k.,lY ? ...lt. ..YY.? ..f ,.1..? ?i ..-. . <br />.? <br />w. <br />+. <br />„ <br />. <br />. <br />. <br /> $ ? Annual Biiling ? Semi Annual <br /> ' <br /> ?' <br />' <br />` <br />rr Quarterly Billing Contract Term <br /> , <br />U? u. <br />& In <br /> <br /> Pfease make check payabie to CMRS-FP <br /> ? ent Enrollment <br />P <br />t <br />P <br /> aym <br />age <br />os <br /> Check No. - <br /> ? <br />? <br />6 <br />? + Unlimited Resets to be included > <br />Amount ($) <br /> <br />? <br />'+'+ Rate Guard to be included n nw?it k ??' as^?+. Sx03..?d ytVy?gf?'?+,-'rs <br /> F-] Reset Debit (Application Attached) <br /> l <br />t <br />R <br />hl ? ? On Demand Debit (Appiication Ariached) <br /> en <br />a <br />Total Mont <br />y <br />+ If unlimited resets is not checked above, I agree to pay the current list price for each occurrence. (initials required) <br />++ Rate Guard has been explained to me, and I have elected to LI? Enroll El Not Enroll (initials required) <br />? month rentai term (initials required) "4 year initial term will apply unless otherwise selected. <br />"This agreement and the Terms & Conditions attached hereto shall automatically and without any further action by either party hereto, renew for one <br />year periods following the expiration of the initial term and any such renewal terms, unless and until either party hereto provides written notice to <br />the other party ot its intent to so cancel. Such written notice must be delivered no laier than ninety (90) days (or the maximum time period permitted <br />by applicable law) prior to the end of the current term. Cancellation will be effective at the end of the current term. FP can change the monthly rate <br />and fees aRer the initial term, with 30 days prior notice. <br />Cusiorner Acceptance _ <br />:„_ _. ,:-... ... ,. _ ,. . ..,._ .. . .. <br />}'t?1/V 1 .V?r7IL J <br />-Authorized Representative: <br />?J (PRINT NAME) <br />el: 7 i ? <br />Drivers License No: -- ----•------ - Staie: <br />P.Autehorized Signature: <br />? Gaie: ?I <br /> <br />?-F, <br />Dealer lnformation - <br />Dealer Number and Name: (?? ,_ ?k. ? l l?.' , ..,r•}-? - <br />Address: 7l,\- <br />Tei Fax: <br />Sales Fiepresentative: <br />Approval Gy Francotyp-Postaiia, Inc. - ?; ;?- <br /> <br />? Contract Station Meter - USPS Letter must be attached FIA_rnGRENTAGF;_01 Page