Laserfiche WebLink
Contractor Section: <br />Vendor Name I Busine�s Name / UBI Number <br />�..���.Z �-��L-� � <br />State of Washington Confractor License Number. <br />��t �.C�i►��_Q�. �Z✓�r�°'�_��g-�'���1:� <br />Vendor Mailing Address City State Zip <br />Phone Emaii <br />I, the Vendor, agree to receive the Backwater PreveMion Device rebate check direclly for Ihe <br />installation at the above referenced property address. By agreeing to receive the rebate check <br />directly, I agree to the following: <br />1, The Backwater Prevenlion Device rebate amount will be deducted from lhe final invoice <br />given to the property owner for the installation at the property address referenced above, if <br />the total cost of the installalion is gr�ater lhan the rebate. <br />2. I, the Vendor, am a Washington Stale licensed contractor. <br />3. The City of Everetl will send a Federal Form 1099 MISC to me, the Vendor, (or Backwater <br />Prevention Orvice rebate paymenls totaling moro than $600 per calendar year, and will <br />report the same payments to the internal Revenuo Ssrvice. <br />I accepl U�e paYment of the Rackwater Prevenlion Device rebate (rom the City of Everell pendinc� <br />approval of lhe comple�ted Backwaler PreveNion Device rebate package by th� City of [verelt <br />/ i <br />(�� ����:-� - <br />SignaWre of Contractor <br />� � � � S� <br />Dale <br />