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Number
XEROX* , Government Service Agreement Here
1�11111 Jill 1 11
Xerox agrees to furnish and Customer agrees to hire the services of
EquipmentPrice Plan Tenn Hill Cade
to be installed at the address(es) indicated below, subject Solely to the following terms and
conditions: (a) in the case of a federal government agency, the terms and conditions of the
contract between Xerox Corporation and the General Services Administration as revised frorn
time to time: (la) in the case of a state or local governmental agency, the terms and
conditions in Xerox Corporation's Mate and Local Government Price List, as revised from
time to time_ Contract tato. Group No-
e /t V dt r? a GJ Ix I
Customer Name and Billing Address Installation Address
ie 4- . 5 '
Service Agreement Addendum attached [l Yes El No
Earliest Customer Acceptance Date _ '
Equioment Purchase Order Required D Yes Ci No, If Yes Complete Below
Equipment Purchase Order No. From--I--L-TO
Special Reference Number
Customer authorizes initial supplies: Yes-< s`4 N
(Customer`s initials)
Supply Purchase Order No.: Supply Agreement No.:
Sup ly urchase Order Not Necessary � Attached To Follow
°I/Jy Early return of Equipment or other breach
7747 of this Service Agreement may subject
Customer to liquidated damages. See
terms and conditions on the above
referenced contract.
Customer's Signature Xerox Corporation
7
T;'.! No8.ar ch.
032 l5178!Printed in U S A
WED
XEROX& Government Service Agreement be
Xerox agrees to furnish and Customer agrees to hire the services of
Equipment Price E'!att' Term &11 Cie
to be installed at the address(es) indicated below, Subject solely to the following terms and
conditions: (a) in the case of a federal government agency, the terms and conditions of the
contract between Xerox Corporation and the General Services Administration as revised from
time to time-, (b) in the case of a state or local governmental agency, the terms and
conditions in Xerox Corporation's Mate and Local Government Price List, as revised from
time to time. Contract No, Group No,
Customer Name and Billing Address Installation Address
, &
r F
}{ c/.2
Service Agreement Addendum attached ❑ yes No
Earliest Customer Acceptance Date
Equioment Purchase Order Required yes Ulleo, If Yes Complete Below:
Equipment Purchase Order No.: From To � 1
Special Reference Number
Custom,or authorizes initial supplies: Yes ff f o
(Custorner's roti (s)
Supply Pu rchase Order No : Supply Agreement Flo.:
Supply Purchase Order L `J Not Necessary 0 Attached 1 o r-ollow
Early return of Equipment or tatter breach
of this Service Agreement may subject
Customer to liquidated damages. See
terms and conditions on the above
referenced contract.
Custorner ,s<.-"tu€e :erox.�or oration
e
"or rn 51u,32(5178f Printed in U S A.