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<br />------- <br />~ ~ ---- --------- <br />--... -~. ~ -........... ...... ----~ ~ <br />~ -----.- ~ ----- ----- <br />. ~ -A TOSHIBA COMPANY- <br /> <br />CUSTOMER AGREEMENT "Retained Title" <br />SALES REP NO. <br /> <br />1 )7)-- <br />-'- _. . _ 0 <br /> <br /> <br />SUPPLies <br />~~~.i:"'oP...~....~,~~or\.~:".'i:lW2i'~~~":t~,,(!""R,;~~,t;",;,.~X;;/' ~~ ." . "'"..::",:' ;' ;'s"'" . <br />~~~ ~~J.UA.t.....~;:... __~~~~",L~_~,~"'; <br /> <br />ACCOUNT :J NEW <br />: E.MAiL ADDRESS ACCOUNT NO. <br /> <br />4 <br /> <br />5 <br /> <br />6 <br /> <br />7 <br /> <br />8 <br /> <br />9 <br /> <br />10 <br /> <br />REPLACEMENT 0 <br />NET ADD 0 <br /> <br />PURCHASE <br />TERMS <br /> <br />DIGITAL INSTALL SUPPORT PLUS 0 1 <br />SUPPORT PLUS 0 2 <br />a LEASE <br />a RENTAL TERMS <br /> <br />UP TO TWO (2) HOURS <br />UP TO FOUR (4) HOURS <br /> <br />CANCEL MIA <br />aYES ONO <br /> <br />o Cash Net Due On Delivery <br />o Other <br /> <br />Amount $ <br /> <br />Date <br /> <br />Total No. of Months <br />S <br />Advance payment(s) of first and last <br />Total amount of advance $ <br /> <br />$ <br /> <br />S <br /> <br />S <br />PO NO. <br /> <br />_,_,- <br />_,_,- <br /> <br />PAYOFF <br /> <br />s <br /> <br />Amount $ <br /> <br />CKNO. <br /> <br />s <br /> <br />Good Till <br /> <br />DELIVERY <br />INSTRUCTIONS <br /> <br />Delivery Oate_'_I_ <br />o AM :I PM <br /> <br />o Sales Rep. 0 Copyco Delivery <br /> <br />Payable to <br /> <br />Account No. <br /> <br />ACCEPTANCE: THIS AGREEMENT IS NOT VALID <br />UNLESS SIGNED BY AN OFFICER OF COPYCO. <br /> <br />X <br />AUTHORIZED CUSTOMER SIGNATURE <br /> <br />PRINTED AUTHORIZED CUSTOMER NAME <br /> <br />OFFICER APPROVAL <br /> <br />X <br />OElIVIRY ACCEPTANCE SIGNATURE <br /> <br />In the 8"ent ttle equipment 1$ not paid for 3nd tl1erefore pcked up lner will be a $.05 per cooy usage ct~a(ge .)nd a reasonable pICkup charge <br />DELIVERY CHARGE: FAX THRU SEGMENT 3: 575.00 SEGMENTS 4: $125.00 <br /> <br />ACCOUNT NO. <br /> <br />.-.. <br /> <br /> <br />5~j-(' of <br />F( q (0 -"'~vr <br />~ <br />COv-3?O-DO-1 <br />~~~ <br />0\\7) <br />\?,v <br /> <br /> <br />- <br />J <br /> <br />o Lead <br /> <br /> <br />Monthly Payments of <br />. plus applicable taxes. <br />month. <br /> <br />Originator <br />C::l Call In <br />SUPPUES <br />o Delivered by Rep. <br /> <br />o Self Generated <br /> <br />o Shipped by Corporate Supply <br /> <br />o Delivered with Equipment from Stanch <br /> <br /> <br />FOR SERVICE AND SUPPLIES CALL 1-800-526-7926 . WWW,CO C <br /> <br />CORFORATE HEAOOUARTERS <br />1011 SW 30TH AVENUE <br />JEERFiELD BEACH Fl 33442 <br />:954\428-1300 <br />'AX (954) 429-3083 <br /> <br />SALES. SHOWROOM <br />1700 PQlMRUNE RD SUITE H <br />DEERFIELD BEACH. FL 33442 <br />(9541 428-1300 <br />FAX (954) 48Q.6713 <br /> <br />BRANCH OFFICE: <br />001 NORTHP\JINT PKWY. SUm: 120 <br />'MOST PALM 8EACH. FL 33407 <br />i56116B4-2300 <br />FAX [561] 6164598 <br /> <br />8RANCH OFFICE: <br />14394 COMMERCE WAY <br />MIAMI LAKES. Fl 33016 <br />[305J 826-9700 <br />FAX [305) 826-3350 <br /> <br />BRANCH OFFICE <br />3212 SOUTH US 1 <br />FORT PIERCE. FL 34982 <br />15611 46 H1224 <br />FAX 1561146Oii640 <br /> <br />TOSHIBA 8LJ5If\ESS SOLUTlONS OMSi[ <br />2815 DlAECTORS FUN. SlE 700 <br />OALANOO. FlOOlOA. 32809 <br />(407J 852.1110 . (lUll 27(} 1869 <br />FAX (407) 816-1511 <br />