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Rev. 12/2/2021 <br />Agreement Acceptance <br />Prices are valid for 30 days and based on the equipment and service information listed above. Environmental (5% up to <br />$75.00) & Consumable Fee’s ($15.00), Sales and use taxes not included. National Power Terms and Conditions of Service apply to any <br />order based on this offer and are incorporated by reference herein. A copy of these terms is available at <br />https://www.natpow.com/resources or may be obtained from your National Power sales representative. We accept payment by check, <br />VISA, MasterCard, and American Express. <br /> <br />Signature: ____________________________ <br />Name: ____________________________ <br />Date: ____________________________ <br />Phone: ____________________________ <br />Email: ____________________________ <br />PO# ____________________________ <br /> <br />Please remit payment to: <br />National Power, LLC <br />Dept. #346 <br />P.O. Box 1000 <br />Memphis, TN 38148 <br /> <br />Pre-authorize National Power to make repairs up to the below amount, <br />please initial by your choice. <br />____________ Decline <br />____________ Up to $500 <br /> <br />____________ Up to $1,000 <br /> <br />____________ $1,000 and above <br /> <br />____________ Refueling up to 100 gallons during PM <br /> <br />DocuSign Envelope ID: 55438DE8-EA22-41E4-BB1C-6B061A8D4C8D