Sales Consultant. Primary Contact Email Please enter a valid email address that will definitely reach the Primary Contact. 8 xxxx.xxxxx@xxxxxxx.xxx Primary Contact Phone Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). Please provide the accurate and current phone number where the individual who will be primarily responsible for all TIPS matters and inquiries for the duration of the contract can be reached directly. 0000000000 Primary Contact Fax Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 1 0 Primary Contact Mobile Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 1 1 0000000000 Secondary Contact Name Please identify the individual who will be secondarily responsible for all TIPS matters and inquiries for the duration of the contract.
Sales Consultant. Secondary Contact Email Please enter a valid email address that will definitely reach the Secondary Contact. xxxxxxxxxx@xxxxxxxxxx.xxx Secondary Contact Phone Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). Please provide the accurate and current phone number where the individual who will be secondarily responsible for all TIPS matters and inquiries for the duration of the contract can be reached directly. 0000000000 Secondary Contact Fax Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 1 6 0000000000 Secondary Contact Mobile Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 1 No response Administration Fee Contact Name Please identify the individual who will be responsible for all payment, accounting, and other matters related to Vendor's TIPS Administration Fee due to TIPS for the duration of the contract. Xxxxxx Xxxxxxxx Administration Fee Contact Email Please enter a valid email address that will definitely reach the Administration Fee Contact. 1 xxxxxxxxx@xxxxxxxxxx.xxx Administration Fee Contact Phone Numbers only, no symbols or spaces (Ex. 8668398477). The system will auto-populate your entry with commas once submitted which is appropriate and expected (Ex. 8,668,398,477). 2 0 7814622339
Sales Consultant. Sales Consultant shall mean those persons or entities approved by IMPAC and listed on Exhibit C to act on behalf of Elekta in fulfilling Elekta’s obligations under this agreement
Sales Consultant. 2nd Sales Consultant (The signatory who by his/her signature hereto certifies that he/she has been authorised to act for and on behalf of the Sales Consultant.)
Sales Consultant. I acknowledge that all items checked have been reviewed with All items checked have been reviewed with the customer. me. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ _ _ _ _ _ Customer Signature / Date Consultant Signature / Date The dealer agrees to electronically submit this completed Mobility Conversion Service Agreement to BraunAbility im mediately after the customer review takes place. Additionally, the dealer agrees to maintain a copy of this executed documen t, with the appropriate signatures affixed, for a period of six ( 6) years. To ensure that completed records are maintained by the dealer, BraunAbility shall periodically audit the applicable records to determine dealer conformance. The dealer agrees to cooperate with BraunAbility in providing copies of these reco rds. Failure to comply with these terms may nullify any obligation that BraunAbility may have to pay warranty claims submitted b y the dealer. I acknowledge the above agreement. Record the last eight digits of the vehicle identification number (VIN) in the space provided for future refer- ence. This information must be provided when filing a warranty claim or ordering parts. Vehicle Identification Number (VIN) LIMITED WARRANTY
