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BILLING INFORMATION <br />Agreement Number. 500-50823891 <br />This form is required for De Lage Landen Financial Services, Inc. to properly bill and credit your account. Please <br />complete this form and return it with the signed documents. <br />ENROLL IN PAPERLESS BILLINGI <br />Paperless F' Convenient Access your invoices anytime, anywhere, from any device <br />Sign me up for Email Invoicing. Send my invoices to the email address below: <br />Email Address(es): a c.o un+s Pay c► h ►ems s 6� • N E T <br />NOTE: Your invoices will be emailed from noreply@notices.leasedirect.com. <br />Subject line will be: "Your Lease Direct Invoice is ready to view onlinel" You will not receive a physical invoice if you elect paperless billing. <br />Billing Name: City of Sunny Isles Beach Phone: 1--1 Z "' q-0 T <br />Customer Contact Email (if different from above): Billing Address: I `70 COl b nS Avenue <br />StreetAddreas or PO Box _ , _ Attention o <br />City <br />FEDERAL TAX ID#: a 5- 0%:9146Y 7 <br />Accounts Payable Contact Information (if different from above): <br />state <br />Name: Email: Phone: <br />Additional Details <br />Do you require a Purchase Order Number on the invoice? <br />If yes, please provide the PO# or forward a copy (front $ back) for our file. <br />Is a new purchase order required for each new fiscal period? <br />If yes, provide monthlyear PO expires: <br />Do you have multiple contracts, and would like them all billed on one invoice (Summary Billing)? <br />If yes, please provide your contract number: <br />Are you tax exempt? <br />If yes, please forward a copy of exempt certificate or direct pay permit. <br />Do you require ourW9 to establish us as a vendor? <br />Are there any additional billing requirements to ensure timely payments? <br />Zip <br />Yes ❑ No <br />Yes ❑ No <br />❑ Yes );it No <br />Yes ❑ No <br />—A Yes ❑ No <br />Payment Information <br />O Pase oheok this.bpifareineesedienollinginAut6 ay. <br />n <br />For other forms of payment, please note the. following remittance address (it may differ from address for service and <br />supplies). Please include remittance slip with payment and send to: PO BOX 825736, PHILADELPHIA, PA 19182-5736 <br />This form completed by: Name: 'al% _ Obanrlo Title: ��-} tn�>n fi t - Date: g, 2 j2 <br />Page 1 of 1 23ANC054V2 <br />433 <br />