CONTRACT 5723C AmendmentUpgrade Order Form
ER Contact Details
Prepared By Greg Anderson
Email greg@emergencyreporting.com
Customer Contact Details
Account Name EI Segundo Fire Department (CA)
Contact Name Scott Martinez
Phone (310)524-1990
Ship To 314 Main ST
EI Segundo, CA 90245
County Los Angeles
Order Summary
Vision Plus with Google Maps VP5
Vision Setup Fee UV -S1
Summary
Bill To Name EI Segundo Fire Department (CA)
Bill To 314 Main ST
EI Segundo, CA 90245
# Years 1
Payment Schedule Yearly
1.00
1.00
Initial invoice will be issued upon receipt of the order form. If this
represents a problem for the accounting department please contact
your sales rep.
Department Information - `Required to Process Order if applicable.
FDID:
FDID
19065
Terms & Conditions
Agreement No. 5723C
Phone (801)935-1822
Fax (866)929-6157
ER Account ID
7333
Quote Number
00018556
Expiration Date
3/31/2019
Customer Type
Existing
$900.00
$408.00 15.00 i
Year 1 Total
Yearly Subscription
$0.00
Fees
Annual Vision Fee
$900.00
Annual Interface
$0.00
Fee
One -Time Setup
$346.80
Fees
Data Import Fee
$0.00
Total Training Cost
$0.00
Year 1 Cost
$1,246.80
Estimated Yearly
$900.00
Total: Year 2+
EMS ID:
Emergency Reporting
2200 Rimland Dr., Suite 305
Bellingham, WA 98226
www.emergencyreporting.com
Phone: 866.773.7678
Fax: 866.929.6157
$900.00 Annual
$346.80 One -Time
Original Order Form Terms & Conditions Apply to this Upgrade Order
PLEASE FAX SIGNED QUOTE TO 1-866-929-6157 OR SCAN / E -Mail to orders o0emeraencvrenortina.com
Original Order Terms & Conditions Apply Agreement No. 5723C
Order Agreement
'° I
Print Namew ^' '" x.
Title
Phone #
Signature
Date
Select Billing Frequency:
If no billing cycle is selected, the account will automatically be billed
Yearly.
Monthly [ ] Yearly," ]
Billing Contact:
Invoices and billing related information will be sent electronically to
this contact. If lett blank ER will use the primary contact information
of this o
listed
at a Name��"T to"��r° � rpa.�,
p C
Emailu
LA
Would you like to receive a copy of your invoice via mail please check
here: Mail[ ]
Mailed invoices will be sent to the billing address list above.
Original Order Form Terms & Conditions Apply to this Upgrade Order
PLEASE FAX SIGNED OUOTE TO 1-866-929-6157 OR SCAN ! E -Mail to orders0emeroencvreoortina.com