HomeMy WebLinkAboutUpper Kittitas County Dist Court Postbase Vision FP Meter Rental AgreementShipping & Installation Address (if different than Billing)
Customer:
Department:
Street:
City: County:
State: Zip:
Tel: Fax:
E-mail:
Contact Name:
Mailing Address: Same as Billing
Existing Customers Only: check box if Shipping & Install Address has changed.
Customer Agreement
FP Mailing Solutions
140 N. Mitchell Ct, Ste 200
Addison, IL 60101-5629
Tel: (800) 341-6052
www.fp-usa.com
CUSTOMER INFORMATION
RENTAL INFORMATION
Quantity Item # Item Description Monthly Rate Rental Billing Delivery (select one)
Electronic Billing
Paper Billing
Rental Billing Frequency (select one)
Annual Billing
Semi-Annual
Quarterly Billing
Term of Contract: months* Total Monthly Payment $
Terms and Conditions: By signing below, I hereby acknowledge and agree that FP’s standard shipping rates and the additional terms and conditions available on the FP website at
www.fp-usa.com/terms-conditions are applicable to, and incorporated by reference into, this agreement. (If you do not have access to the internet, please contact FP directly at
800.341.6052 and we will provide you with a copy for your records.) * 36 Month Initial Term will apply unless otherwise indicated above.
CUSTOMER ACCEPTANCE (please complete all fields)
Customer Acceptance of Terms Dealer Information
Print Name of Authorized Representative:
Selling Dealer Name:
Dealer #:
Tel:
Address:
Tax ID:
State:
Tel:
Fax:
Authorized Signature: X
Sales Representative Name:
Date: Servicing Dealer Name:
Svc. Dealer #:
DEALER & INTERNAL USE ONLY
New Customer
Upgrade / Model Change
Renewal (no change of equipment)
Coterminous Add-On: ____________________________
Change of Ownership
Existing Account No.:
Lease Company:
Major Account:
GSA / State Contract No.:
Master Billing Acct. No.:
Master Postage Acct. No.:
Promo Code: _____________________________________
Package Code: ___________________________________
Price or Terms Exception Approval (Form Attached)
USPS® Location: (CPU Letter Attached)
Tax-Exempt (Certificate Attached)
FM_MG_RENTAGR_12 Page 1 revised 4/3/2018
Billing Address
Customer:
Department:
Street:
City: County:
State: Zip:
Tel: Fax:
E-mail:
Contact Name:
Deliver To: Dealer Customer Fulfilled from Dealer Inventory
Existing Customers Only: check box if Billing Address has changed.
Note: If a payment option is not selected, FP
will default to Quarterly Paper Billing.