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Lease#T99046 <br /> ATTACHMENT ONE <br /> Payment Request Form <br /> The Agent is hereby requested to pay from the Vendor Payable Account, by and among the <br /> Lessor/Assignee to the person or corporation designated below as Payee, the sum set forth below such <br /> designation, in payment (of all/a portion) of the Acquisition Costs described below. The amount shown <br /> below is due and payable under a purchase order or contract with respect to the Equipment item cost <br /> described below and has not formed the basis of any prior request for payment. <br /> Please forNard this document and any correspondence relating to vendor payments to: ABN <br /> AMRO Incirporated, Attn.: Cheri Cattoor, FVP, 1675 Broadway, Ste. 850, Denver, CO 80202. <br /> Please call 800-825-7505 if you have any questions. <br /> Payee: <br /> Amount: <br /> Description of Equipment Item Cost: <br /> Dated: , 19 <br /> LESSEE:City of Batesville <br /> Signature <br /> Name: <br /> Title: <br /> Date: <br /> LESSOR/ASSIGNEE: ABN AMRO Incorporated <br /> Signature <br /> Name: <br /> Title: <br /> Date: <br /> is <br /> 14 <br />