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Acceptance and Authorization Template - PDF by nvj15162

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Acceptance and Authorization Template document sample

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									             DELIVERY AND ACCEPTANCE FORM
This Delivery and Acceptance Form makes reference to the attached Non-Cancelable Commercial Equipment Lease
Agreement bearing Authorization Number                                    . The attached Lease Agreement is
incorporated herein by reference.

Equipment Description:



                                                                                                              ,
as more particularly defined in the attached Lease Agreement.

General Information
1)   Please indicate the address and description of address where the Lease Agreement was signed:
     Address                                          City                           State        Zip
2)   Description (e.g. business, home, hotel, etc.):
3)   Please describe how you were introduced to your Equipment Vendor:


Lessee Initials Required
           I agree that the Equipment has been delivered as I requested, I have inspected the Equipment, it is in
           good working condition and I unconditionally accept same. I understand my obligations under this lease
           become irrevocable upon my acceptance of the Equipment.
           This Lease is a NON-CANCELABLE Commercial Equipment Lease Agreement between the Lessee
           and TimePayment Corp. This Lease is for _____ months and the base monthly payment is $_______
           (plus applicable taxes, tax processing fee and loss or destruction waiver). I understand that the total
           amount of sales tax on the equipment is due in advance in the states of Illinois, Maine and New Jersey.
           This has been paid by TimePayment Corp. and has been included in your base monthly payment. No
           written or verbal alteration of this Lease Agreement is valid.

Signature Required

LESSEE #1:                                                         TimePayment Corp.
                  (Print Name)

LESSEE #2:
                  (Print Name)                                      Authorized Signature                   Date



Lessee #1 Authorized Signature             Date




Lessee #2 Authorized Signature             Date



             10-M Commerce Way, Woburn, MA 01801 ٠ Toll Free: 877-868-3800 ٠ Fax: 781-994-4775
                                       www.timepaymentcorp.com
             DELIVERY AND ACCEPTANCE FORM
This Delivery and Acceptance Form makes reference to the attached Non-Cancelable Commercial Equipment Lease
Agreement bearing Authorization Number                                    . The attached Lease Agreement is
incorporated herein by reference.

Equipment Description:



                                                                                                              ,
as more particularly defined in the attached Lease Agreement.

General Information
1)   Please indicate the address and description of address where the Lease Agreement was signed:
     Address                                          City                           State        Zip
2)   Description (e.g. business, home, hotel, etc.):
3)   Please describe how you were introduced to your Equipment Vendor:


Lessee Initials Required
           I agree that the Equipment has been delivered as I requested, I have inspected the Equipment, it is in
           good working condition and I unconditionally accept same. I understand my obligations under this lease
           become irrevocable upon my acceptance of the Equipment.
           This Lease is a NON-CANCELABLE Commercial Equipment Lease Agreement between the Lessee
           and TimePayment Corp. This Lease is for _____ months and the base monthly payment is $_______
           (plus applicable taxes, tax processing fee and loss or destruction waiver). I understand that the total
           amount of sales tax on the equipment is due in advance in the states of Illinois, Maine and New Jersey.
           This has been paid by TimePayment Corp. and has been included in your base monthly payment. No
           written or verbal alteration of this Lease Agreement is valid.

Signature Required

LESSEE #1:                                                         TimePayment Corp.
                  (Print Name)

LESSEE #2:
                  (Print Name)                                      Authorized Signature                   Date



Lessee #1 Authorized Signature             Date




Lessee #2 Authorized Signature             Date



             10-M Commerce Way, Woburn, MA 01801 ٠ Toll Free: 877-868-3800 ٠ Fax: 781-994-4775
                                       www.timepaymentcorp.com

								
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