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<br />tHE DOCUMENT COMPAWT <br />XEROX <br /> <br />* * DOTTED AREAS * * ORDER AGREEMENT THE DOCUMENT COMPANY <br />To be completed by the Sales CBR. INTERNAL DOCUMENT <br />All other areas to be completed by sales rep. XEROX <br /> <br />Icusro~NUmber ~~~~~=N=~m~eRaß~5~Oó~~fi'llfI~õ~ ,:=~u~:ruummm: <br />Ic~i~/a:;£ Redwood C i t Y 1°5'i6~er Loc ¡Install Rep Loc u u ¡~ ;äi; II9;~äi; ~ Warr Moo ;E2i 9~D 1~~9;œ I <br />~:r::iList# Ir~~n~/~~/P;;'õõZtiPromo 'uumummm lientalPriœList# ,uuu.t;¡;k.MktGuideArtide(S)#ll~'i.~~ l <br /> <br />:ConfiJ:, Overrideouuuu,Override Data Unit ru Commission Waiver Code m o,Network ID u °tooli~ ID uuu ououuuuomo~PooIinJ: ID/Type (not CPC related) m: <br /> <br />..uu"umumo uhom.uummuU u_u uuomohum"uuumu "..- <br />Tax Exempt Tax Codes u,o Tax Overridesumomo uumuuu muuu 0 u,uGeoCode u <br />:_c::J :!~~~~~~é:L~t~t~:u:mJ<::()~I1t;::ouui~it;:::"."uLgfT&D OP&A ORent OSale h.g9t~~ruj~~~t~:u <br />Mid. SeJ:ment Code Sid. hxI. Code (SIC) Install Establishment # Nature of Business <br />GOV Ci ty Government <br />NUMBER OF EMPLOYEES <br />at the Customer's Location <br />1. 0 1-9 5. 0 100-499 <br />2. 0 10-19 6. 0500-999 <br />3. 020-49 7. 0 1000-1499 <br />4. ~50-99 8. 0 1500-2499 <br />9. 0 2500+ <br /> <br /> <br />u~ <br /> <br />METER READS <br />On place eqwpment) <br />1. <br /> <br />2. <br /> <br />3. <br /> <br />4. <br /> <br />CUSTOMER INVOICING REQUIREMENTS <br />r State and LocaI--------____--_m_------x--j ŒlOutbound 0 InboWld 0 RlC <br />L Contract._-----------------_! 0 MeterCollection 0 Fax 0 Meter Cards <br />Fed. Gov't (cœck aU that apply) <br />Contract # 0 Single Invoicing 0 EIo<.1IOnic Invoicing ~ <br />0 GovemmentFirmContractOption ŒlSummaryInvoicing 0 EIectronicFWldsTransrer ~ <br />0 Government Fiscal Year Option 0 Fmance SOIrnmny <br />GovemmentFiscaI Year Begins: 0 EBS Statement Invoicing <br /> <br />IIMI <br />CODE <br /> <br />5. <br /> <br />ill <br /> <br />Supplies Automaric Replenishment Print Volume Adj. <br />.. Required fur Supplies Induded Madùnes <br /> <br />ŒlEstimated Print Volwne (EMCV) 50,000 <br /> <br />0 Monthly Print Volumes (fill in all months) <br /> <br />Supplies Automatic Replenishment Shi~ To Address <br />. Required for Supplies Induded Madùnes <br /> <br />0 Shi~ To Address Below <br /> <br />ŒI Same as Install Address <br />Attn Name Silvia Ponte <br />Contact Name Silvia Ponte <br /> <br />Jan <br />May <br />Se <br /> <br />Feb <br />Jun <br />Oct <br /> <br />Mar <br />Jul <br /> <br />Nov <br /> <br />Apr <br />Aug <br />Dee <br /> <br />Phone 650-780-7221 <br />Special Delivery Instructions <br /> <br />Delivery / Installation Requirements <br />Delivery Contact: Silvia Ponte <br />Altemate Delivery: <br />Survey Con1act: <br /> <br />Silvia Ponte <br /> <br />Phone: <br />Phone: <br />Phone: <br /> <br />Ex!. <br />Ex!. <br />650-780-7221 Ex!. <br />Flooring: 0 Carpet ~Tile 0 Marble 0 Otber <br />Doorway Width RICIFAX#: <br />~Rails Needed? <br /> <br />650-780-7221 <br /> <br />Delivery LocationlDept: Copy Room Floor #: 2 Room #: <br />Delivery Entrance: ŒlFront 0 Back 0 Side Delivery Hours 8:00 To 4:00 <br />0 Loading Dock I&IElevator : ~Passenger 0 Freight 0 Upend Required? <br />0 Staircrawler ŒlTech. Rep 0 Steps # Landings # <br />~Space Ready? ŒlSite Cleared? 0 Supplies Ordered 0 Stand / Table Reqwred? <br />~In place equipment I furniture needs to be moved prior to delivery? 0 Telephone Line Ready? <br />ŒlElectricity I Receptacle Ready Power Cord Type Volts 115 Amps ~ <br />0 20 Amp Receptacle To Customer Customer 20 Amp Receptacle installed? 0 Yes ~No <br />0 Custorrer acknowledges request to be billed for Xerox Service Installation charges on customer installable equipment? 0 Software <br />0 DTR Site Verification required? 0 Obstruction I obstacles in the delivery path? If checked, explain in space to the right. <br />~lnstallation Preparation Document reviewed? ŒlCustomer Satisfaction Cbecklist Completed? <br />ŒlSolutionQuiX was used to validate this configuration. <br />~Pick up trade unit at time of delivery? Date: 05/05/2000 <br />Make: Xerox 1090 <br />Competitive Equipment Replacement Tag#: <br />* * EXCEPTION APPROVALS SHOULD BE OBTAINED BY SALES REF PRIOR TO SUBMITTING ORDER TO CBR * * <br />Signatures below indicate approval for the items checked on the left <br /> <br />- NOTES- <br />Order Mobility Plates, Door to Copy Room must <br />be removed or turned around prior to delivery to <br />fit 51 OOA space requirments <br /> <br />ERC Code: <br />Model: 1090 <br /> <br />~Repack Kit? <br />Serial Number: M08031980 <br /> <br />Check all that apply: <br /> <br />0 Competitive Trade-In Range Extension Promotion <br /> <br />0 XTI I CTI I CRP Headquarters Exception Approval <br />0 Waiver of Rental ETCs <br /> <br />0 Other <br /> <br />0 Other <br /> <br />0 Other <br /> <br />Date <br /> <br />CB U Manager, Sales OperalIons <br /> <br />CBU Controller <br />Populated From Pricing: <br /> <br />Date <br /> <br />DocuBroker Form# 51869H (10/1997) <br /> <br />4/1412000 <br /> <br />Internal Use Only <br />