90-01 Zerox Order Agreement?e -
Xerox Order Agreement
'Customer agrees to the following transacttorl and the incorporation of the Xerox standard terms and conditions rotating thereto for the acquisition of Xerox Equipment,
.Supplies and/or Service described below antl In the attachments hereto:
❑ Maintenance Only
❑ Equipment Services ❑ Installment Purchase of Equipment: ❑ With Maintenance ❑ Software License
O Equipment Purchase: ❑ With Maintenance ❑ Financed. Equipment Configuration Change 11t rm Lease
Blit To
Installed At
Customer Name ^ !
Customer Name
Parent Co.
Relerences are
(II different)
Name Overflow
Box #/Routing
Floor. Room,
Maintenance
Routing
Street Address -. .r
Street Address
City
State
Zip -
City
State
Zip
General Order Information:
Purchased or Prepaid Software License
Installment Purchase
City.
Q
#
Xerox Product (Ser. if in place)
List Price
Total List $
Less Deductions -.
Net Price
.
BTotal Net
Opt. to Purch.
Trade-in
Other
Price
Xerox
C. Cash Down
Payment
Xoox -
D. Cash Price
e
(Principal
Balance
Xerox
(B- CI)
E. Finance
-
-
Charge
or Interest
Xerox
at p/p
F. Time Balance
%xpz
(D. E)
eras.
G. Time Sete
Price IC a F)
Xerox
Monthly Installments of
Xerox
Meters
A. From Attached
$
( Total Net Price of
1. 2.
Order Agreements
B. Total
(Exclusive
Sales/Use Tax, Placement.
S 4
Maintenance and Supply Charges)
Existing Equipment to be Replaced (List Serial Numbers) Initial Supply Order
Tax Exempt ❑ No ❑ Yes (Attach Exemption Certificate)
Customer Requires Purchase Order Number [],No ❑ Yes
Customer Purchase Order Number
Purchase Order
Equipment
Relerences are
for Billing
Purposes Only.
Maintenance
Reorder Number
Prepacked supplies will be shipped with selected
Equipment and billed to the customer at the Pre -
packed price in effect at the time of installation.
Prepacked supplies will be removed, free of
chargeand with full credit If requested
by Customer.
Customer Requests Full Credit
Earliest Customer Acceptance Dale _// I I Supply P.O p
Master Purchase Agreement #
Equipment Services
Price Plan Description
Initial
Xerox Supply Cont #
Billing Cycle
Complete This Section For Term Lease:
Term of Agreement (Check One Plan)
❑ 24 Month ❑r�48 Month ❑ Other
❑ 36 Month MO Month
Original Customer/Contract 096
Purchase Option Amount $ —
Purchase Option Amount
From Attached Agreements) $
kMonthly
O Semi Annual _
D Annual _;,I>
;opy Charges will be baled separately in
ccordance with the Maintenance Price List
From Attached Order Agreements)
Total Monthly Minimum Lease Payment I. _
Exclusive of Sales/Use Tax and Placement Chgsl r
Contract Number
Gov't. Firm Contract Option ❑ Gov't. Fiscal Year Option ❑ Gov't. Fiscal Year Begins —/—/_ K-12 Summer Option
Equipment may be newly manutmiumd, mmanufactured or previously neutral se described in site Xerox Pries LM or may be in -lilacs. Consumer meat Meal W acknowlMge
recall of the Xerox Fell List. Terms and Constitute and other docemerrts designated babes:
frati le r milieu ladiau
Xerox Price List # / dated E Term Lease Terms and Conditions dated r a Other
Xerox Maint, Price List lidated F. Full Service Mand. Terms and Conddated dated
Gov't. Contract/Price List # datetl _ G. Standard Maint Terms and Agreements dated
A. Equipment Order/Agreemengsl dates N. Equipment Tratle-In Terms and Conditions dated
B. Equipment Services Terms and Conditions dated i. Software License Terms and Conditions dated
C. Equipment Purchase Terms and Conditions dated_ — J. Extended Service (Warranty) Amendment dated
—
Sales Rep. Ord., Acknowledgement
D. Inatal Imam Purchase farms and Uondnlons Cared_ t. Negotiated 6odraet
Customer - Xerox Corporal On Installment Purch
By IPleax Print) — - _. � ' Term Luse Customer No: 95 _ _ _ — — — _
Signature - - _ Signature
_ Accepted fair Xerox
Title r:. Date , / " r + , Title Date
Delivery Contact Phone Ext. Site Cleared: Ll Yes ❑ No Order Agreement of
Form 59502 (5/85)
CUSTOMER
