Pure Planet Water/Water Systems 08
DOLPHIN CAPITAL CORP.
POST OFFICE BOX 56
1720A CRETE ST.
MOBERLY, MO 65270
Rental' SelVice Agreement
Pure Planet Water
Water systems
Agreement #
.3
Customer Billing Address (if different)
SAME
Address
City
State
Salesperson
County
Zip
Fax
Q1Y
EQUIPMENT AND PAYMENTS
UNIT DESCRIPTION RATE PER UNIT
Term of
Agreement
Payment '" I l'
Amount: 0''"\
~nthlY
C Quarterly
C Annuall Total First Pa ment Due:
SPECIALINSTRUCllONS L oe..... ~On.s: <"'flo ~ ("e.el-
F,.....o........c.e..- ce..rt-.) Ad ~.... 1"\ ;+-~ @.:oC.
S"
1ST Payment in
Advance $:31
Delivery &
Installation Charge $
Supplies (See
Below) $
RATE TOTAL
'qfj)
-
SUBTOTAL
Sales Tax $
Total
o
o
o
o
.
'''-j
Total
Sales Tax $
Total
PLEASE READ BEFORE SIGNING: THE CUSTOMER AGREES TO RENT FROM VENOOR THE EQUIPMENT USTED MilNE. THE CUSTOMER AGREES
TO ALL TERMS AND ODNDmONS CONTAINED IN THIS RENTAL AGREEMENT. THE CUSTOMER AGREES THIS RENTAL AGREEMENT IS FOR THE
RENTAL TERM INDICATED M!lJVE AND CANNOT BE CANCELLED FOR ANY REASON.
ITEM TV
CUPS
CUP
HOLDER
STARTER
KIT
TOTAL
SUPPUES
CASE TOTAL
PRICE PRICE
INmALS