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<br />TOSHIBA <br />BUSINESS SOLUTIONS <br />Florida <br /> <br /> <br />CUSTOMER AGREEMENT <br />~~ t-!AMj: <br />d:5"<e//4'l- <br /> <br />37633 <br /> <br />SALES REP NO. <br /> <br /> <br />ORDER STAGE NO. <br /> <br /> <br />ACCOUNT <br /> <br />[J NEW <br /> <br />[J EXISTING <br /> <br />ACCOUNT NO. <br /> <br />COUNTY <br /> <br />STATE ZIP + 4 <br /> <br />4 <br /> <br />5 <br /> <br />6 <br /> <br />I <br /> <br />9 <br /> <br />10 <br /> <br />11 <br /> <br />DIGITAL INSTALL <br /> <br />SUPPORT PLUS [J 1 <br />SUPPORT PLUS [J 2 <br /> <br />PURCHASE With Credit Approval <br /> <br />[J Cash Net Due On Delivery <br /> <br />PO No. <br /> <br /> <br />No. of Months <br />Monthly Payments <br />$ ,. <br />$ <br /> <br />plus tax. <br />First & Last _ months rent. <br />Security Deposit <br /> <br />Credit Card No. <br /> <br />CKNo. <br /> <br />Accessability <br /> <br />PAYOFF TO: <br /> <br />[J Stairs <br /> <br />[J Ramp <br /> <br />[J Loading Dock <br /> <br />Check Request Form Required Y I N <br /> <br />o GEM Express <br />Contract # tJ <br /> <br /> <br /> <br />BUYOUT (Quote Required) <br /> <br />UPGRADE Y / N <br /> <br />ACCEPTANCE: THIS AGREEMENT IS NOT VALID <br />UNLESS SIGNED BY AN OFFICER OF TOSHIBA <br />BUSINESS SOLUTIONS. <br /> <br />X <br />OFFICER APPROVAL <br /> <br />X <br />MANAGER <br /> <br />~:Do-.v'p SG..W\SbN ~ <br />PRINTED CUSTOMER SIGNATURE ) <br /> <br />CORPORATE HEADQUARTERS <br />1011 S.w. 30TH AVENUE <br />DEERFIELD BEACH, FL 33332 <br />(954) 426-1300 <br />FAX (954) 429-9083 <br /> <br />SALES. SHOWROOM <br />1700 POWERLlNE RD.. SUITE H <br />DEERFIELD BEACH. FL 33442 <br />(954) 428.1300 <br />FAX (954) 48().6713 <br /> <br />BRANCH OFFICE <br />175 N. FLORIDA MANGO RD.. SUITE 3011#5 <br />WEST PALM BEACH. FL 33409 <br />(BOO) 526.7926 <br />FAX (BOO) 526-7906 <br /> <br />BRANCH OFFICE <br />14394 COMMERCE WAY <br />MIAMI LAKES, FL33016 <br />(305) 826.9700 <br />FAX (305) 826-3350 <br /> <br />BRANCH OFFICE BRANCH OFFICE <br />3212 SOUTH U.S. 1 2815 OIRECTORS ROW. STE 700 <br />FORT PIERCE. FL 32982 ORLANDO. FLORIDA 32809 <br />(561) 461.8224 (407) 852.1110. (BOO) 270-1869 <br />FAX (561) 460-6640 FAX (407) 816-1511 <br /> <br />FOR SERVICE AND SUPPLIES CALL 1-800-526-7926. www.copyco.com <br />