2023-486-E-AMS-southern air-Prevenive Maintenance Agreement- Whitted Buildingt

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Name: Corporation Partnership Individual If Corporation, Name of Registered Agent & Address: Type of Business Duns# Year Established Federal ID# or SS# Tax Exempt Status Yes No If yes, Please attach Tax Exempt Form Service Address: Phone Number: Fax Number: Onsite Contact: Quote Contact: Billing Address: Phone Number: Fax Number: A/P Contact: Will a work order or PO be issued for Service: What is the work order NTE: Bank Reference: Bank: Contact Name: Address: Phone Number: Account Number: Trade References: (Failure to provide current credit references, including contact information requested, may delay the processing of your application.) 1. 2. Phone: Fax: Phone: Fax: Contact: Contact: 3. 4. Phone: Fax: Phone: Fax: Contact: Contact: I hereby authorize the above listed bank and trade references to release information to Southern Air, Inc. In consideration of Southern Air, Inc.’s extending credit, the applicant agrees to comply with Southern Air, Inc.’s payment terms of NET 30 days. The applicant will pay 1.5% per month for amounts due past 30 days and 33.3% collection and/or attorney fees. Jurisdiction for any dispute shall be Lynchburg, VA. All of the information above is correct, and I have read the above payment agreement and will comply with the terms. (Owner/Officer/Purchasing Agent) Signature (Date) (Printed Name) (Date) • Headquarters: 2655 Lakeside Drive P.O. Box 4205 Lynchburg, VA 24502-0205 • Phone: (800) 743-0747 • Roanoke • Harrisonburg • Winchester • Charlottesville • Tidewater • Richmond • Bluefield • Fredericksburg Customer Information for Commercial Accounts N/A N/A Yes Orange County Government 56-6000327 Multiple Locations Hillsborough, NC 27278 Paul Sorrell PO Box 8181 Hillsborough, NC 27278 919-245-2625 919-201-6829 DocuSign Envelope ID: F276DE55-1B05-417C-9C6E-426AF3151AE4 9/8/2023