Hercules Plus CDMA Rental Agreement, Canada, 1 of 2 Phone: 800-561-8880, Fax: 506-847-2348, eMail: email@example.com 53 Clark Road, Rothesay, New Brunswick, Canada, E2E 2K9 Please note that this form may be easily filled out on your PC, printed, signed off and faxed to the number indicated. Otherwise, PLEASE PRINT CLEARLY. Company Name Billing Address City Province Postal Code First Name Last Name Title Phone Mobile Fax eMail Ship To Address (if different than above) First Name Last Name Title Phone Mobile Fax eMail Item Rental / Month Purchase Quantity Extended Totals Hercules Plus Basic Service $30.80 n/a $0.00 Hercules Plus Extended Service $38.50 n/a $0.00 Signal Booster n/a $300.00 $0.00 Alarm Module n/a $100.00 $0.00 AC Disconnect n/a $100.00 $0.00 Signal Strength Module n/a $35.00 $0.00 20' Antenna Extension n/a $25.00 $0.00 40' Antenna Extension n/a $30.00 $0.00 9" High Gain Antenna n/a $15.00 $0.00 Standard OEM Antenna n/a $15.00 $0.00 Total Less Tax = $0.00 Plus Shipping and Tax of 5% Please Note: BC Tax 12%, NB Tax 13%, NL Tax 13%, NS Tax 15%, ON Tax 13% By signing below customer confirms that GPRS was offered to them as a first option; and customer is specifically choosing CDMA network. Agreed Upon by: Name: Title: Signature: Date: Hercules Plus CDMA Rental Agreement, Canada, 2 of 2 Phone: 800-561-8880, Fax: 506-847-2348, eMail: firstname.lastname@example.org 53 Clark Road, Rothesay, New Brunswick, Canada, E2E 2K9 Please note that this form may be easily filled out on your PC, printed, signed off and faxed to the number indicated. Otherwise, PLEASE PRINT CLEARLY. Purchase Order Number Credit Card Number Expiration Date Visa Mastercard Cardholder Name American Express Check to indicate you want your Monthly Service Fee charged to your Credit Card each month. Invoices overdue for thirty (30) days or more may cause messaging service to be deactivated. Please note: we have recently had to implement a $20.00 processing fee to handle Credit Card payments that were declined. In the future this fee will be added if funds are not available on or about the 15th for your current messaging billing. Select Your Service Provider Calypso CashNGo DirectCash On-Line Open Solution TNS The monthly Rental Fee entitles the user to 2000 transactions per month. A transaction whether approved or refused counts as a transaction. Overages on the 2000 transaction count will be charged at the rate of .03 per transaction. Customer Preferred Courier Customer Shipping Account Number Unless specified, default shipping is by Ground Use Customer Shipping Account Number DPL to Prepay and Add Ship Ground Ship Air Warranty: Warranty is good for as long as the Rental Agreement is in good standing excluding loss and physical damage. The DPL Group is not liable for the loss of ATM Machines, cash or business transactions. The DPL Group's liability is limited to replacing a defective unit provided an RMA number is obtained first. Please Note: Rental units are not transferrable. Should a Rental unit no longer be required, monthly billing charges will continue until the unit in question has been received and inspected by The DPL Group.
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