|
REQUEST
FOR “SPEAK and VOTE COMBO”
PLEASE FILL OUT THIS FORM AND FAX IT TO 949 858 0505 |
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| ________________________________________________________________________ | __________________ | ||
| Name of person making request | Title | ||
| ________________________________________________________________________________________________ | |||
| Name
of City, County, Board or Commission |
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| ________________________________________ | _________________________ | ______ | _________ |
| Street | City | State | Zip Code |
| _______________________________________ | _________________________ | ||
| Phone Number | Fax Number | ||
| ________________________________________ | |||
| Preferred Five
Day Trial Period If Available (Allow
3 days for arrival) |
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| ________________________________________ | |||
| Alternate
Five Day Period |
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| This request will generate a Memo Billing for for $1,295.00 which will be credited upon return of the system in an undamaged condition – freight damage excepted. Execution of this request form acknowledges acceptance of these terms. Please retain shipping carton for return use. | |||