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3 �� g THE DOCUMENT COMPANY <br /> XEROX <br /> **DOTTED AREAS�' * ORDE�. AGREi IENT THE DOCUMENT COMPAIVY <br /> To be completed by the Sales CBR INTERNAL DOC � f EIVT <br /> All other areas to be completed by sales rep XEROX <br /> C�tomerNnt�ber 95CuNOmerNumbv �--�-SakRao�e Works6eef/lJ�it Product -- ..QrlerNunber ---°--.....� <br /> .........._. <br /> -- -- -- - - ----- ---- 540 � 1� 100A : <br /> � ustoo�xName MakerLac�IroWReP�-�-�"d�+�4� IsW1Emp11 WtrMos.EqdpBCU . ' -----. ""Iyant,BCp� <br /> City of Redw City � 5 � ; 985813� 985813 : ; Z �a1 <br /> '�--- ••- �Pp�nn�c,�:aeen�.lr u� <br /> Sale P�ia liet N Mint Ri�e I�t k/ Plan DesaiV� ReoW Pnae iBt �/ A <br /> COL7► rCOLA/D�11C 5100A Ptono � - �I � 3L6Z � <br /> CaiEi4 .................... • ;Paoi�m/TypelaolCPCrdaled) <br /> i ; : . PoahoRID ..................- --......_....°--° <br /> ....... ........ ........ ....E... ............._°-----. :-............. - ........... . i <br /> . ...- - -.°°--- -°----°°-�---°°-°-.°.........° - <br /> . .. <br /> . . <br /> u -�---° -- - rTaxCodn---- --�-•-� . ............---........°-----......... TnO�ereidn °--..................._::::�_::::::.:..----.:- °.°--�--� �asCode..:: ----.°.-.-. •--:....:-°..:..°-.::...::_:..:-°--.°°--- ...._ <br /> ;❑= Tax Exempt ': State: � County : � City : ❑PT&D �P&A �Rent OSale DOther ; State : County City <br /> . ..........- � - -.... �-----�--�� . ............................�---� .._......--�- - �� .................. ------- ...1.....- � .... � .............1...._...:.. ...............: <br /> 1N10. Sepnmt (',uae �Sia inu: �ude (SiCi -- ino,u Eda616hmase N n�e dsu�ors vnn in ae6rat aOW�c <br /> �V City C3ovarameat gg � <br /> NUMBER OF EMPLOYEES CUSTOMER IIWOICRVG REQUDtF.I�!'IS <br /> M p«R READS ) at the Cus[omer's I.ocarioo �S1aleaod I.aeal � � ❑� ❑� <br /> � 1. ❑ 1-9 S. � 100-499 CO°a' � Me�coueano ❑ eax ❑ Maca� <br /> �. �. ❑ iai9 � � soo-� F c �: c����n�� <br /> 2. 3. ❑ 20-49 7. ❑ 1000-1499 ❑ GovaumeiK l�9re Cmtract Optloo ■ S°ye mwcmg ❑�ravo�ic mwc�g <br /> �Samm�'InvoiciiB ❑F�cva�FuWikad'v omfde <br /> 3. 4. �50-99 S. � 1500-2499 ❑ Gorasoeot [�d Yar Oplia� <br /> �.o�s�y <br /> 4. 9. � 2500+ � F3td Year Bepee ms sur�ma Nwici� conE <br /> 5' m <br /> soppties nirom.oc xeplmienmar rriot voWme na} SuQp�a Aubme�c Repla�mme S6ipTo nabea. <br /> � Rqdred tar S�piia led�d[d M�ma ����PP�+� 1►tichie <br /> �Faemrea rr:u vamrc ceMCV� saooe ❑ snipro nm�a� eebw Bs.me a Imao ,+m�.. <br /> ❑ Mooihly Ptet Vokmra (fi0 in all montlis) Nm Name S�7via Puire <br /> Cme�.K Name S�lvi� Poo�e <br /> Jan Feb Maz Apr �na�e 654'�so�t2� <br /> May hm Jul Aug <br /> spe�.i �sv«r t�� <br /> Oct Nov pec <br /> Delivery / Ioswllation Requfrements <br /> Delivery Contact: Silvia Ponte Phone: 650-780-7221 Ext. <br /> Altemate Delivery: Phone: Eat. <br /> Survey Contact: Silvia Ponte Phone: 650-780-7221 Ext. <br /> Delivay I.ocadoo/Depr, Copy Room Floor M: 2 Room K: Floaring: ❑ Carpet OTik ❑ Marbk .❑ Ot6er <br /> Detivery Enaance: �Fro� ❑ Bacic ❑ Side DeGvery Fluurs 8:00 To 4:00 Doorway Width RIC/FAXA: <br /> ❑ Loadieg Docic �Ekntor : �Pusenger ❑ Feeigtu ❑ Upeod Requued'! �Rai1s Needed? - NOTES - <br /> ❑ Staircrawkr �Tech. Rep ❑ Stepa N I.aadings 1� Order Mobility Plates, Door to Copy Room must <br /> ❑x Space•Resdy? �Siu Ckared? ❑ Supplies OrdeRd ❑ Swd / Tabk Required? bo iemoved or tumed around prior to delivery to <br /> �In place equipment / fumiture needs to be moved prior to delivay? ❑ Tekphone Lirc Ready? �t S100A space roquirtnenfs <br /> �Electricity / Raxptack Rwdy PowQ Cord Type Vohs I 1 S Ar�a 30 <br /> ❑ 20 Amp Receptack To Customer Cusromer 20 A� Reoeptack inatalkd? ❑ Yes �No <br /> � Customer aclmowbdgas raryrst m be billed ta Xaox Scvia lawalladoo chargea on aummer i�tlabk equipment? ❑ Softwue <br /> ❑ DTR Site Verificadon required? ❑ Obatrucdon / obs�acles in the deGvery path? If cAecked, explain in space to the right <br /> �Instaltation P�eparation Document �eviewed? �Customer Sadsfaction Checklist Compkted? <br /> OSolutionQuiX was used ro validate this coa6guradoa <br /> �Pick up Uade unit at time of delivery? Date: OS/OSf2000 ERC Code: �Repack Kit? <br /> Make: Xerox 1090 • Model: 1090 Serial Number: M08031980 <br /> Competitive Equipment Replacement Tag#: <br /> ** EXCEPTION APPROVALS SHOULD BE OBTAINED BY SALES REP PRIOR TO SUBMITTING ORDER TO CBR ** <br /> cn�k au �� �iy: Signatures below indicate approval for the items checked on the left <br /> ❑ Cortyxtitive Trade-In Range Extension + ;ion <br /> • ❑ XTI / CTI / CRP Fleadquarters Exceptio�. oval anager, a es perat�ons gt� <br /> d Waiva of Rental ETCs <br /> ❑ Ottcr <br /> ❑ o�� ontro er � ' �6 e - <br /> ❑ ocher Populated Tiom Pricing: <br /> DocuBroker Form# S1869H (10/199'7) 4/14/2000 Intemal Use Only <br />