Text · page 28 of 34
Read the whole document on one page (all 34 pages, each with its own heading)
This document was a scan. Its text was produced by character recognition and may contain errors; check the original for exact wording.
Portal Setup Contact: (* all fields required) Name*: Title*: Office Phone*: Cell*: Email*: (This person is responsible for placing the iWorQ Portal Link being placed on the Portal Setup Contact Signature*: agency's website within 90 days of the agreement signature. The iWorQ Portal Link will remain on agencies website for the entire Term of the agreement. If the iWorQ Portal Link is not placed on the city website within 90 days, the Agency agrees to pay an additional $1,000 dollars towards setup costs (this is to cover iWorQ's time). 11. CUSTOMER BILLING INFORMATION: (* all fields required) Billing Contact*: Title*: Billing Address*: Office Phone*: Cell*: Email*: PO #: Tax Exempt ID # (required): Note: If a tax-exempt number is not provided, a 10% service increase will be added to the yearly invoice. 12. ACCEPTANCE: (* all fields required) The effective date of this Agreement is listed below. Authorized representatives of Customer and iWorQ have read the agreement and agree and accept all the terms. Effective Date*: Signature*: Printed Name*: Title*: Office Phone?®: Cell*: Unless otherwise stated, Service Period starts the first day of the month after signature and Effective Date. Org ID: 20746 iWorQ Systems Deal ID: 120594 P.O, Box 3784, Logan, UT 84323