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<br />FEB.24,200911:24AM CASS CTY SOCIAL SVS-.'. ..-.-.-,.. .........----.......-NO.612' - p, 1/2-....... <br />~~~~~ EQUIPMENT MOVE ORDER <br /> <br />OUlLET # <br /> <br />CONTRACT # <br /> <br />6009162 <br /> <br />EQUIPMENT #: <br /> <br /> <br />C~l!eK APPUCABLIi: <br />o PRESENT CUSTOMER <br />[J NEW CUSTOMER <br />o THIRD PAR'TY <br /> <br />CCE OUTLET PHON5 <br /> <br />cce OunET NAME <br /> <br />CHIiCI( ONE: <br />o INSTALLATION [J DATA CHANGE <br />I::J PICK.UP <br /> <br />DOCUMeNT #: <br />DIVISION/LOCATION #: () ~/'" yr; <br /> <br />TO DAY'S DATE <br />REQUeSTEOINSiALLDATE <br />ReQUESTED P/U OAT! <br />O~L1VERY HOURS <br /> <br /> <br />AAFES # <br />THIRD PARTY SITE INFORMATION <br /> <br />NAME <br />ADDRESS <br /> <br />[J LOAN Iwl FULL SERVICE <br />D TEL-SELL 6'" !-lOME MARKET <br /> <br />o I.EASE <br />o OI;POSIT <br /> <br />COMMISSION (CREDIT TO) INFORMATION <br /> <br />NAMe <br /> <br />t.1IN REQ PURCHASE, pe~ MONTH <br /> <br />LEASE RATE <br /> <br />PAYAAEQ. <br /> <br />FS COMM CODE 30 I..$: PURCHASE AMOUNT <br /> <br />FS VEND PRICE 70 PAY METHOD <br /> <br />FS COMM FREO (1 PAY RATE <br />TAX I.DJSac SEC t#ORV Lie # _________ <br />NAMi: ON ID CARD <br />REPI"ACE COMPETITION (PROVIDE; COMP NAME) <br /> <br />ADDRIi$S <br /> <br />CITY <br /> <br />STATe <br /> <br />;cp <br /> <br />PHONE <br /> <br />ATTN: <br /> <br />CUSTOMER AUTHORIZATION <br /> <br />",.... oquIpIllIIllMCI .-.-nt1llMMnfieit\t wNliI1.....ln ~ de-.c.a..... <br />hanobj'__ rarln~ IlNlerIM _and ."ndtll.....tall<l........... <br /> <br />X <br />CUSTOMER SIGNATURE <br /> <br />DATE <br /> <br />I SEASONAL ACCT. [J YES Jta NO I EXCLUSIVUCCT. ~ 'I'D 0 NO I <br />SHAREO ACCT: WITH WHOM: <br /> <br />PRlNi NAME <br /> <br />TITLE <br /> <br /> <br />CCM12S4 <br />CONTOUR VENDOR <br />WITH VALIOATOR <br />EQUIPMENT <br /> <br />A T <br />DOOR CAN VENDOR II 80T'T1..E VENDO~ 0 <br />o <br />Oil YES 0 NO <br />o NEW USED <br /> <br />MODEL -1JlI :g(J 8" <br />CAPACITY <br />OPTIONS <br /> <br /># SEI.,ECTIONS <br />SIZE LIMITS _ H_ W _ 0 <br /> <br />INITIAL ORDER, <br /> <br />UP DOWN <br /> <br />SAl.ESPERSON: <br /> <br />DATe <br /> <br />/ / <br /> <br />AUTHORIz!;D BY: <br /> <br />DATE <br />