Laserfiche WebLink
, <br /> i <br /> i <br /> Backwater Pre�iention Device <br /> _ - Rebate Program ! <br /> ; <br /> � <br /> Vendor Section (please print): i <br /> ��'����Fg�u'S--I L.U,11 !l)(? ��Ji �_ %/ �� U1- �,�7-� C���� � <br /> �-- - -� W---___—.--' i <br /> Vendor Name /[3usiness Name/ Ul31 Number � <br /> r_. nn,�GA.�=��L����------- ' <br /> Sntate ol Washington Contrar.lor License Number � � <br /> _t'_L. C�— ;)�i�lL _Fv���`i�f i�r� �'l �S � <br /> --- ��-- ` <br /> Vendor R4ailing Address Cily State Z�p � <br /> � <br /> ��.`�. �5��i - :'�'S9iS ��'��'ICC� cs���Am�l)�'��5 Iva�f)�r�c <br /> .__.----�---------�--�--- -- (uiN1 i <br /> � PhOne —'_'f-- — <br /> ;___ <br /> [mail I i <br /> _ _ - --- - -- --- - - 1 <br /> I, the Vendor, agree to receive the Eiackv��ater Prevenlion D�vice rebate r,heck directly � <br /> (or the instaliation referenr,ed at lhe Property Address. E3y ayreeing to receive the rebale � <br /> check duectly, I agrce to ihe followiny j <br /> 1. �he Hackwater Prr.vention Device rebale amowtt will be de�luctr.d frum the (inal � <br /> invoice given to ihe Property Ov,�ner for the installation at ihe Property Address � <br /> referenced ahove, rf lhe total r,ost o(lhe installation is greater ihan the rebate. � <br /> 2. I, the Vendor, am a W�shington 5tote hcensed r.ontractor <br /> 3 I he City of Fverett will send a Feder��l Porm 1099 Iv11SC to me, ihe Vamdor, (ar ' <br /> the Backwater Prevention Device rebale payrn�nts totaling more Ihan $600 per <br /> r,alendar year, and will ruport lhe same paymenls to ihe Intemal Revenue � <br /> . f'NICE!_ <br /> I <br /> I accept fh,: direct payment of lhe F3��ickw�ter Prr..vention Dewce rebale from ihe City � <br /> i <br /> of Everett pendntg aapprovra{ o(the coniple(���d f3ackw�ler Pievenlion Device rebafi� <br /> pack�ye by �he�iLy_q( EwmHt <br /> / <br /> % / i <br /> ` .. '—�_ /�-�'�,._ ,-..--1�'� �._. . ��'/� Z.V/�' � <br /> �� _. --- -- -- - � _� I <br /> Sign��tu � ol Controctor Dete --— � <br /> I <br /> � <br /> F����sed s���zo�a <br /> f�ge 2 of 2 � <br />