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BSFS Equipment Leasing, <br />A Component of General Electric Capital Corporation <br />Lessee: Indian River Cou <br />Agreement No./Schedule No. <br />Federal Tax ID Number- 59-6000674 7297850-001 <br />(NOTE: FEDERAL TAX ID NUMBER MUST BE PROVIDED WITH SIGNED DOCUMENTS) <br />If your taxing jurisdiction requires Lessor to pay sales tax up front, WE WILL ADD THIS <br />AMOUNT TO YOUR PRICE (as set forth in the Lease) unless you direct us to bill you for the <br />sales tax by checkinq below: <br />❑ Invoice Lessee for upfront sales tax: do not add to Price. <br />Please note: If you have elected a $1 Purchase Option, then you are responsible for <br />promptly reporting and paying personal property taxes. <br />To insure we bill you correctly, please review the questions below. If the information on your lease <br />documents is correct, you do not need to complete the blanks, only check the Yes box next to that section. <br />If the information on the documents is incorrect, please insert the correct information below. <br />Information on documentation correct? <br />❑ Yes ❑ No <br />Information on documentation correct? <br />❑ Yes ❑ No <br />Billing Address: <br />Billing Contact Name: <br />Phone Number: <br />System Installation Address: <br />City: <br />Zip: <br />County: <br />If applicable, enclose a copy of Lessee's Purchase Order. <br />Purchase Order Number: <br />Start Date: <br />iration Date: <br />State: <br />Please indicate your sales tax status below. <br />The system is exempt from sales tax. Q ❑ No <br />Yes <br />If the above answer is no, please sign below and return with the lease documents. <br />CADocuments and Setdn9s\shadMDesktop\Indian River SLG $bo .doc SLG 11/1/99 <br />