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HOBART <br /> <br />CORPORA~'ION <br /> <br />BILLING LOCATION <br /> <br />SERVICE <br />CONTRACT <br /> <br /> Business Name Cass County Jail <br /> Address 450-34th St S <br /> <br /> Fargo Cass <br /> (City) (County) <br /> <br />INSTALLATION LOCATION (it different than above) <br /> <br />(Street) <br /> <br />Business Name <br />Address <br /> <br /> (City) (County) <br /> <br /> Hobart Servicing Office Far~;o, ND <br /> <br />COVERAGE DESCRIPTION <br /> <br /> Type Dishwasher Only / Yearly <br /> <br /> Multi-year Coverage <br /> <br /> Days <br /> <br />EQUIPMENT TO BE COVERED ! PRICING <br /> Model / Item / <br /> Device No. Description Serial No. <br /> <br />(Street) <br /> <br />Months <br /> <br />Hours <br /> <br />Special Provisions <br /> <br />Installation <br />Date <br /> <br />FT9?? D~ shwmsher ?7115977 8/19/02 <br /> <br />Select one of the available advance payment options: <br /> [] ANNUAL (Single Payment) [] QUARTERLY (4 Payments) <br /> [] SEMI-ANNUAL (2 payments) [] MONTHLY 02 payments) <br /> [] TRI-ANNUAL (3 payments) [] EVERY FOUR WEEKS (13 payments) <br />*(Annual Rate must be based on payment option selected) <br /> <br />YOUR ADMINISTRATIVE REQUIREMENTS [] Consolidated Invoice: <br /> [] Installment Notice: <br /> (Not applicable to annual payment option) <br /> <br />ACCEPTANCE <br /> <br /> ]- Number of Copies <br />__ Number of Copies <br /> <br /> ACCEPTED BY USER: <br />.¥ <br /> (AUTHORIZED USER SIGNATURE / TITLE) <br /> <br /> Invoice Address (Same as installation <br /> location unless specified below): <br /> <br />ISERVICE BILL TO - CUSTOMER CODE <br /> <br /> (Name) <br /> <br /> (Street) <br /> <br /> (City / County / State / Zip) <br /> <br />F.1944 (R12-00) COPY ! WHIRR - PSD <br /> <br />NO. <br /> <br />ND <br /> (State) <br /> <br />(State) <br /> <br />140567 DATE 11/24/03 <br /> ISERVICE BILL TO- CUSTOMER CODE <br /> <br /> Phone {701 )271-2954 <br /> <br />Service <br />Contract <br />Rate <br /> <br /> 58108 <br /> (Zip Code) <br />lEND USER CUSTOMER CODE <br /> <br />(Division, if Applicable) (Store Number) <br /> <br />$??75 <br /> <br /> (Zip Code) <br /> <br />Distance from Office 5 <br /> <br />miles <br /> <br />[] Seasonal <br />circle covered months: <br />J F M A M J <br />J A S O N D <br /> <br />Department and Location <br />(if applicable) <br /> Name / Number <br /> <br />SUB-TOTAL <br /> <br />PM ADDENDUM CHARGE <br /> <br />EQUIP. ADDENDUM CHARGE <br /> <br />TAXES <br /> <br />TOTAL ANNUAL CHARGE <br /> <br /> [] Fiscal Year End Date <br /> [] Effective Start Date <br /> Purchase Order Required <br /> <br />ACCEPTED BY: <br /> <br />Total* <br /> <br />$2275 <br /> <br />By <br /> <br />Date <br /> <br />I 1111! Sll $ & <br /> SBIIIICE <br /> 18 $ Hill Street <br /> <br />COPY 2 YELLOW - PSD / CUSTOMER COPY 3 PINK - SERVICING OFFICE <br /> <br />Fargo HO 56103 <br /> <br />2775.00 <br />XXXXXXX <br />XXXXXXX <br /> <br />XXXXXXX <br />2275.00 <br /> <br />12/1/03 <br /> ~[1Yes []No <br /> <br />COPY 4 GOLDENROD - SUSPENSE / SERVICING OFFICE <br /> <br /> <br />