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<br />-P <br /> <br />p~RKeon <br />..9-: <br />~.........~ <br /> <br />Service Application Form <br /> <br /> SERVICE List Price/ Total Price and Invoicing <br /> unit! year <br />Extended Maintenance Agreement <br />Model <br />0 Strada BNA Qty: 3 $635.00 <br />Standard Coverage <br /> o Extended Parts Warranty <br /> o Remote Telephone Support <br /> liT Preventive Maintenance Kits <br /> liT 20% Discount on Parts and Labor <br />Additional Services $52.92/month/machine P&D <br /> D Preventive Maintenance Visit <br /> D Pre-Paid On-Site Support _Hrs <br /> D Remote Auditing Services <br /> D On-Site Auditing Services <br /> D Graffiti Removal <br />Training <br /> D Technical Training (Moorestown) <br /> 0 Technical Training On-Site <br /> D WEB Training MyParkfolio <br /> <br />o Billing - Monthly <br />o 30 Day Payment Terms from receipt of invoice <br />o Auto Renewal (12 month terms)(30 Day Cancellation Notice) <br /> <br />D Additions to existing contract <br /> <br />D Additional Fees: S <br /> <br />D Start Date I I <br />(initial tenus of this contract is one (1) year from the above start date) <br /> <br />This Application Form, the General Terms and Conditions and the Schedules constitute the Agreement to which this application applies. <br /> <br />For "Customer's Name" <br /> <br />For PARKEON <br /> <br />Date: / / <br />Name:~-r-~~UtJ <br /> <br />;ii:~:tur:1 M~ <br /> <br /> <br />By slgning I confirm that, <br /> <br />Date: 1 / I Y / II <br />Name:KtW~ UOLAJ~r)( '1', <br />Title: ~ - t-J AM <br />Signature: /"'0 ~ \ <br />V""V <br /> <br />_ I have read, understood and accepted the general terms and conditions of this <br />agreement. <br /> <br />_ All information provided in the Service Application Form is true and complete and <br />oroperly reflects the business <br /> <br />2011 7 11 Services Agreement Final.doc <br /> <br />Paraphs: <br />