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Acceptance of Quote # Q-84353-1 <br /> <br />The undersigned has read and agrees to the Binding Terms, which are incorporated into this SOW, and have caused this <br />SOW to be executed as of the date signed by the Customer which will be the Effective Date: <br /> <br />For CivicPlus Billing Information, please visit https://www.civicplus.com/verify/ <br /> <br /> <br />Authorized Client Signature <br /> <br />CivicPlus <br /> <br />By (please sign): <br /> <br />___________________________________ <br />By (please sign): <br /> <br />___________________________________ <br />Printed Name: <br /> <br />___________________________________ <br />Printed Name: <br /> <br />___________________________________ <br />Title: <br /> <br />___________________________________ <br />Title: <br /> <br />___________________________________ <br />Date: <br /> <br />___________________________________ <br />Date: <br /> <br />___________________________________ <br /> <br /> <br />Organization Legal Name: <br /> <br />___________________________________ <br />Billing Contact: <br /> <br />___________________________________ <br />Title: <br /> <br />___________________________________ <br />Billing Phone Number: <br /> <br />___________________________________ <br />Billing Email: <br /> <br />___________________________________ <br />Billing Address: <br /> <br />___________________________________ <br /> <br />___________________________________ <br />Mailing Address: (If different from above) <br /> <br />___________________________________ <br /> <br />___________________________________ <br />PO Number: (Info needed on Invoice (PO or Job#) if required) <br /> <br />___________________________________ <br />V. PD 06.01.2015-0048 <br />Page 3 of 3 <br />Docusign Envelope ID: C801B106-E693-4F08-8752-DF2C495963F4