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e <br /> 5. <br /> signage on the equipment and may provide additional funding for this purpose. Company invites your <br /> department to contact us to discuss any additional marketing or public relations assistance we can <br /> provide on your behalf. <br /> Finally,as a way to demonstrate the overall impact of this grant program,Company asks that the <br /> Department provide documentation demonstrating the effect the funding has had on operations.This can <br /> be documented via E-mail, letter, photos,video,or however the department sees fit. We request that this <br /> impact be documented and shared with Company within six months of the receipt of the grant or donation <br /> or as special calls occur and the grant funds helped make a difference. <br /> By signing this agreement,Department agrees to carry out the aforementioned activities as <br /> planned. <br /> Agreed to and Accepted: <br /> Department: <br /> By: (X) <br /> Date: <br /> Print Name and Title: <br /> Dept.Tax/Fed ID#: <br /> Make Grant Checks <br /> Payable to: <br /> Send Check to: <br /> (No PO Boxes) <br /> If check is being mailed directly to a vendor: <br /> Vendor Name: <br /> Contact Name: <br /> Tax ID Number: <br /> Street Address (NO <br /> PO Boxes) for check <br /> to be sent: <br /> PLEASE PRINT LEGIBLY <br /> Page 2 of 2 <br /> 71 <br />