Municipal Information Form

Step 1 of 7

Municipal Information Form

Customer Information

Date

City/Town Name(Required)

Federal ID #(Required)

Phone Number(Required)

Fax Number

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Shipping Address (if different than Billing)

Street Address Address Line 2 City State ZIP Code

Acknowledgments

Please review the following agreements. This form may be executed by an electronic signature in compliance with Massachusetts law governing electronic signatures. Electronic signatures shall be considered as valid and binding as original signatures. Documents exchanged electronically (i.e., by email or fax) shall be treated as valid and binding the same as original documents.

Credit Agreement & Terms of Sale

The applying customer, and its parents, subsidiaries, successors and assigns (“Customer”), agrees to the terms of sale herein and as they may be stated, modified or amended on invoices from Ballard Mack Sales & Service, Inc. (“Ballard Truck Center”) to Customer. Credit shall at all times be limited to such amounts as Ballard Truck Center shall, in its sole discretion, determine, including providing no credit. The Customer shall be responsible for all charges incurred by its employees or agents, unless the Customer provides prior written notice restricting the persons authorized to deal with Ballard Truck. Invoices are due Net 30. Acceptance of less than the full invoice amount by Ballard Truck Center shall not be construed as a waiver of the right to full payment. The Customer agrees that interest shall accrue at the rate of 1.5% per month or the maximum allowed by law, whichever is less, on any delinquent amounts. The Customer agrees to pay all costs of collection, including attorneys’ fees, incurred by Ballard Truck Center upon breach of this agreement or any invoice. This agreement shall be governed by the provisions hereof and the laws of Massachusetts. The parties both WAIVE THE RIGHT TO A TRIAL BY JURY in any action to enforce the terms of this agreement or in any dispute with Ballard Truck.

Signature for Acceptance of Agreement(Required)

Acceptance of Agreement Signer's Name(Required)

First Last

Acceptance of Agreement Signer's Title(Required)

Date