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HomeMy WebLinkAboutCanon Financial Services, Inc. - Copier Lease and Maintenance for Codes Division canon ACQUISITION AGREEMENT LEASE OR PURCHASE CANON SOLUTIONS AMERICA Canon Solutions America, Inc. ( "CSA ") One Canon Park, Melville, NY 11747 (800) 613-2228 l i �/ ( Salesperson .Jr _ Order Date: 1 t -./ O / 1 r t , = *; a , .. _4 r T ` I Customer Acco nt: i i 5 ! Customer,(yauj - Customer Account: Shtp+ o / r �� /' Company: t- 9i f , ,\ A N( /t1. 1 Company: e 1 1 1 [ 1 F i , Address: ' L t o'. C 114,4 ( Address: ( 2s l N' .2/0' _1C City: County: v City: �/� County: State::// / N S LIT (1,00.5 I Phone #: State: p � J-A ` Zip: q a i I Phone #: , - 55 1 ,5 6 Contact: Fax #: Contact: Fax #:1_ sad 575 t< - Email: Email: I, easeffiolgai i ase titi :° , . 1 : ''..'11,'"I,.:: pia( al You agree to lease the items listed below or in any addendum(s) to this Agreement from the Leasing Company identified below, at the fixed periodic lease payments indicated below or in any addendum(s) to this Agreement and for the fixed term specified in the lease agreement between you and the easing Company. Delivery to you of the items specified is contingent on you signing a lease agreement with the Leasing Company. Canon Financial Services, Inc. ❑ Other (Name of Leasing Company): ❑ - You agree to purchase the items listed below or in any addendum(s) to this Agreement, for the purchase price specified. The "bill to" for the items listed is the Leasing Company or you, depending on which box is checked above. i , f �[ ,f ' 679 iv PLEASE PRINT � Equipment Supplies and Licenses of Application Software with listed third party support contracis MO t,t "• c fr '.. : - p ,; . ,, �" , mac $" Periodic Lease:.,.,r" item - ' "� R � � �' v �` � r # • r , , Product description; ' 4 : e „ _ ' . Payment al , ' : i=� �,, ,ti 4,4,,,'N4 .Y �, e.' * ,. ar : _,E. ,,, ,,/,...:* . 1,., , . L „ ru -"` ... . _.�:' ` ,�: 4 _ > te ' x � 1 ., Purch Rnce, ,"c 5S L � r-5� l 1p 'VI 74 -- 1:1_ 365L /� »AA CtIS� ( 119 ( li �9 77 3� 6s siIIti),414, St ( V C y $ , V t - -Lit , :. � acs t:���. c,'stk a:i �,�3 a � "'` . i � ' "�';�. : ^^'�?+r � Subtotal from �/ z'- *f :i - � ' , LP ntTennS An K t _,� : eCRequl4enten Supplemental Addendum 7 ❑ Check with Order Check # P.O. Required Subtotal � J ❑ } et 30 P.O. # Delivery/Install ' r G ]� Lease ❑ Tax Exempt Sales Tax ❑ Other (Attach Certificate) Total ❑ Credit Card: ❑ Customer Declines Deposit Requires submission of secure credit card authorization form. Maintenance Agreement Balance Due - - ;.�;`_� : a , aµ �° ?+ . - �;�; ; rx <= ; - •'�- w. �+. � ro��,}'� - �� =�;. � , . , �.;;;a�•,se.. - w a^e :. i \ Shipping tnstructtons : R 3 Customer Delnrery �f ' "Cu tT;Co °information t. ...h �, t 4444 .x , w+ �' � . - F�a�� �:e - ��,` _ ., �. - - .u� - ,. 7, u, �wzr. a -re. 'Y'- , +aar�: �,.�ro�r �aa.s �s.:a •.,�ur- . + . Vii. Ship Via: Name Email This individual may be contacted for network connectivity. Hours of Operation Phone Earliest Date for Delivery: / / Name Number of Steps Phone Special Delivery/Installation Instruction Elevator Yes ❑ No ❑ Email Loading Dock Yes ❑ No ❑ . BY YOUR SIGNATURE BELOW, YOU AGRE TO LEASE OR P "CHASE, ' ' SPECIFIED ABOVE, THE ITEMS LISTED ABOVE OR IN ANY ADDENDUM(S) TO THIS AGREEMENT. YOU ACKNOWLEDGE R : PT OF A COP OF THI AGRE.• ENT, CONSISTING OF TWO PAGES INCLUDING THIS FACE PAGE. THE ADDITIONAL TERMS AND CONDITION • PAGE 2 HER' OF AN' IN AN / ADDENDUM(S) HERETO ARE INCORPORATED AND MADE PART OF THIS AGREEMENT. A Customer's Authorized Signature Printed Name Ton 0 r • • . - Title ( Mg n age r Date SLS -204 March 2014 (BPC) Canon Canon Financial Services, Inc. 14904 Collections Center Drive Lease Application Chicago, Illinois 60693 CFS - 1040 (01/09) To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who enters into a lease. This means that when you enter into a lease, we will ask for, among other things: (1) your federal tax identification number, and (2) your date of birth, if you are a sole proprietor. We may also ask to see identifying documents. CUSTOMER INFORMATION 1 . Company Legal Name: • DBA Name: L 4) D CLIO Ma Phon J© ! � Fir ( G �` ! Website o .1 r t ] t2 1 1 a ` / 9) 5 75 — U Address: WWW. �. " ( l G V Business Address: City: St ate: • Zip: /Z Al ,2 in (/ S r..t.� ma A ggg ` Headquarters /Parent Address: City: y State: Zip: Contac erson Fo Additio • al Info:______ Ti le: Phone: 5" Email: OSQ,Q,L;i4p- / bar Y21-- r O. /_. t ,L l_. :r. I/ / . i . . W2 /, / A_ .. _ic_..4 _ I i V Type of Business: ; Corporation ❑ LLC ❑ Sole Proprietor ❑ Partnership ❑ Non - Profit IA State Local Government Fed Tax ID #: D & B Number: State of Inc: N,tu of Business: J Years In Business: q1 Cat / III /I I / t PERSONAL INFORMATION Principal's Name: SSN: Ownership •: Home Phone: Date of Birth: Home Address: City: State: Zip: ACKNOWLEDGEMENT AND AUTHORIZATION Customer warrants that all information in this application is accurate. The person signing below, as an individual and as an authorized representative of the customer authorizes the above references, any credit reporting agency, or other third party (including CFS) to collect and release any credit information concerning the above named company or principal (including consumer credit reports) to CFS, its affiliates and their respective designees or assignees. Customer agrees that equipment leased from CF ' be used solely for business or commercial purposes. Customer agrees that a facsimile copy of this Agreement shall be deemed an original, and w' be tr.ated as an original for all purposes. SIGNATURE 4 Signature: Date: _ * "' DEALER INFORMATION — FOR INTERNAL USE ONLY *' * ** 1 Existing Customer? ® No ❑ Yes Customer Number: Lease paperwork signed? ❑ No ❑ Yes Quantity: Make / Model / Description: iii) - Used / Demo: 6 A 1J NJ 52.55 Lease rmi: Monthly Payment: Rate Factor: Purchase Opti : m onths 7 3, 2..}-1 ❑ FMV $1.00 Out ❑ 10% ❑ Other Equipment Cost: Upgrade Cost: CFS Lease Number / Serial Number: Buyout Cost: Lease Company / Vendor: Other Cost: Describe: , Total Amount: MSRP / List Price: /+C _� .4 A _47Atie, r V Dealer: ^ Branch: Sales Rep: 4'. Phone: I C Jo' 575. Email: Fax: ' Notice: The Federal Equal Credit Opportunity Act pr creditors from discriminating against credit applicants (1) on the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract); (2) because all or part of the applicant income derives from any public assistance program; or (3) because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers companies with this law concerning Canon Financial Services, Inc. is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580. CFS -1040 (01/09) Canon MAINTENANCE AGREEMENT CORPORATE ADVANTAGE PROGRAM CANON SOLUTIONS AMERICA Canon Solutions America, Inc. (CSA) Related Acquisition Agreement # One Canon Park, Melville, NY 11747 (800) 613-2228 9. Salesperson AkiZitt Mlih Order Date: / / (7/ ' I Customer t"Yu'): Customer Account: Equipment Location: Customer Account: , ... i Company. 6, •ELM ( i.../ ' -aerE..of L/- Company: 1 _ Address: (2.i ) Address: ' 7 City: , \4 il I County: C +,:. , • I County: State: U I Zip: 2-7 Phone #:/--51,-5 S - -: I Zip: Phone #: 0... Contact . /IA/ . ax #:/,.... 564,....c7 C - 1 - Contact .... Fax #: Email: For each unit of Et/MO Wed, you shall indicate specific contact and location . - .. - . ...„. , .•- -„. . , if differeiit than above in.the tabte below or in an :Addendum to this • • reement . 4i.anlatile .0.4 . . - Base Charge; El CSA 0 Canon Financial Services, Inc. ("CFS") b Yes 0 lIca imageWARE Remote unless noted in table below` Per Image Charge:. Ei CSA El Can tin Financial Services, inc. ("CFS") PO # . W = eManage website 43iii:ettlig - eirc r -MPr-•'' iriiii .. • . . . Monthly Elattattert Doom Months If adcfing EqUipment below to an existing (min. 12) Per arid 0 Fleet 0 Aggmgate Aggregate, provide either a contract # or seriat# under Aggregate. '- ;71kg,*440.7 ,f!,4f.::Iiii:44*.i.c*W$Illii* i.S-WetrOleikirr ,-;:-•-• 4.7e4ter;; Q tort* - 0auarterfy I:father El Standard [ i Toner (en:hetes dear) El Other Subject to tfte brims and CarfeiniertS of ads i R grew:twit, CSA agrees to service the Equipment listed below or in any Achtendurrifs) to this Agreement at the charges stated herein or therein. For newly instard EquipmeM. the Strut Caters provided In Paragraph 1 of the Adciifionat, Terms and Conditions. The Start Date for previously, th place &Flo tient is / / . • i......1 i . 7 Covered Imagee'per Unit or Fleet • included in Base Charge Per trnage Charge in excess Of Base • Model I Serial it i All aggregate imeges shcruld be Ilited per unit. Covered gatages Charge Alt Start M'eter I 6011/7011 - 6011/7011 per unit or ' Meter 13 & W Color i 6 Si VV . Color Long Sheet B &W Color Lon g Sheet Fleet Method* ,.' 1 D071 ; i)50(1 4".....jiii.444 . . Contact Phone #: 1 - - 5 .....‘, i ) Equipment Lac-Adair • Address i 3'i . 4 - -2,( C:-1 . V A:V ,, , u ,} 7 74 c i tidg l Erred . 1 , . 1 i . . , • Contact : 'Phone #: Fax #: - • Equipment Location: - Email Address: • v • 1 1 1 1 . 1 1 • Contact Phone #: 1 Fax #: t• Equipment Location: : Email Address: 1 1 . 1 1 Contact Phone #: Fax #: Equipment Location: I Email Address: Subtotal from Supplemental Addendum CUSTOMER SATISFACTION POLICY ' Subtotal If you are not satisfied with the performance of your Canon or Oce brand product, upon your written request, CSA in its sole discretion will repair or replace the product with a like unit with equivalent capabilities. Prior to replacement, CSA shall have Tax had the opportunity to return the product to good working order in accordance with the terms of this agreement. This policy • shall apply for 3 years from the date of installation or for the initial term • .: y • S Lease, if longer, provided you are not in Total default of this Agreement and such maintenance services have not • - en can . ed or terminated. . BY YOUR SIGNATURE BELOW. YOU AG .i TO PURCHASE HE M • TENANCE SERVICES SPECIFIED ABOVE YOU ACKNOWLEDGE RECEIPT OF A COPY OF THIS AGREEMENT, CONSISTING OF .. , ..ES INCLUDING HIS • CE PAGE. T ADDITIONAL TERMS AND CONDITIONS ON .PAGE 2 HEREOF AND IN ANY ADDENDUM(S) HERETO. ARE INCORr . D AND MADE ' PA OF THIS AG MENT. , 4 1 Customers Authorized Signature — I Printed Name Tony O'Rourke . TiveCity Manager Date I 1 C c [ (. I f SER-223E March 2014 (BPC) CITY CONTRACT NO: ' — r?r RESOLUTION h10:,...,