HomeMy WebLinkAboutContract 49933 CITY SECRETARY
CONTRACT N0Dett .
yil
Financial
Services
BILLING AND LEASE SCHEDULE INFORMATION
(THIS FORM MUST BE COMPLETED BY THE INDIVIDUAL SIGNING THE
DOCUMENTS AND A MEMBER OF YOUR ACCOUNTS PAYABLE TEAM)
1. INVOICING/BILLING:
Will your accounts payable be for:
KI Central Location 111 for each Dept., Campus,Agency(need address for each)
Customer's accounts payable address for invoices
Company Name: CITY OF FORT WORTH
(as filed with your
Secretary of State)
Address: R00 1-EX 12-5 51-2 E67 7-
City, State, Zip: >=fly' t - WOEI N 740/0,-2s IX 74Ul0o
County: 1-1-MPA-49 7—
Attention:
Telephone Number:
Fax Number:
E-Mail Address:
Is a Purchase Order#required on the invoice? XYes ❑No
TAX: Where required, Sales/Use Tax will be assessed and invoiced.
Does the Customer hold a valid exemption or direct pay certificate? XYes ❑No
If yes, please ATTACH a copy of the certificate for each state to this document.
(NOTE:A certificate must be provided for each state in which lease Products are located.)
UCC Information Required:
Federal Tax �J / 000.55 Type �,oUeAlUM�T u
(ilT ! ` �'
• ID#: �J� i� Organization: ! �'
State Of
Organization: �'L: J State ID#:
How will your Purchase Orders be pl ced?Will one Purchase Order cover:
111 Order Release Multiple Order Releases El Blanket Purchase Order
❑1 Ship to Address Multiple Ship To Locations
111 Group Only O Multiple Groups (Depts, Campuses,Agencies)
❑1 Entire Lease Term ❑Specific Periods-Explain
OFFICIAL RECORD
CITY SECRETARY
Reference: Page i of 4
BRRn`information-Public FT,WORTH,TX
Egq
i,
Please Describe your Requirements?
Will Shipping be: ❑Financed ❑Billed Separately No charge by Dell
Can you have: ❑More than one PO#/Invoice Only 1 PO#/Invoice
Can your PO be: XSpIlt between 2 or more invoices ❑Must be fulfilled in 1 invoice
Will you lease: M Dell Equipment only ❑Other Vendor(s)Equipment
Do you intend to finance upfront tax(if applicable)on the Lease Schedules? ❑Yes ❑No
Please Describe your Organizational Structure:
❑Commercial Public/Municipal ❑Other-Explain
❑1 Group Only ❑Multiple Groups(Depts, Campuses,Agencies)
111 Accounts Payable ❑Multiple Accounts Payables(1 per Dept, Campuses,Agency)
❑Lease Schedules will be reviewed by one person ❑Requires multiple step approval process
Commencement is:
❑1 st of following month ❑Acceptance ❑Other-Explain
Interim Rent is:
❑Charged ❑Not Charged ❑Other-Explain
Property Tax is:
❑Rebilled Annually ❑Other-Explain
Fiscal Year is from d' to .o
Notations:
U.PREPARING CUSTOMER'S A/P SYSTEM TO REMIT PAYMENTS TO Dell Financial Services L.L.C.:
Below is information commonly requested by customers in order to assist them in setting up their accounts payable
system to pay Dell Financial Services L.L.C.:
Payee Name and Address:
Dell Financial Services L.L.C.
Payment Processing Center
Carol Stream, IL
Dell Financial Services L.L.C. Federal Tax ID#is: 74-2825828
What information will you require in order to set u payments to Dell Financial Services L.L.C. vs a rec rn g payable?
/N� C/A Il e G �!�T 'Kn n�
E�07- VEAASOk A V L-E
Oc u R 6i t'i i 7?44- „
M. PAYMENT METHODS to Dell Financial Services L.L.C.
VIA CHECK
Mail To: Payee Name and Address:
Dell Financial Services L.L.C.
Payment Processing Center
Carol Stream, IL
Reference. Page 2 of 4
5111Im Information.Public
VIA WIRE TRANSFER
Please reference all information listed below to ensure proper credit each time a wire transfer is made:
Payable to: Dell Financial Services L.L.C.
ABA#: 071000039
Account#: 8188204944
Customer Account#:
DFS Invoice#:
Amount to be Applied per Invoice:
VIA ACH
Payable to: Dell Financial Services L.L.C.
ABA#: 071000039
Account#: 8188204944
Preferred Format: CTX+
Customer Account#:
DFS Invoice#:
Amount to be Applied per Invoice:
IV.LEASE SCHEDULES:
Please refer to the Lease Schedule Sample attached.
Name of recipients)to receive monthly Lee Schedules to reconcile:
Attention:
Address:
City, State, Zip:
Phone ft FAX Numbers:
E-Mail Address:
Name of individual(s)to sign monthly Lease Schedules(this individual should be named as an authorized signatory on
the Secretary/Clerk Certificate):
Attention: I
Address:
City,State, Zip:
Phone It FAX Numbers:
E-Mail Address:
V.LEASED ASSET REPORT
Please refer to the attached Lease Asset Report Sample.
Will you require a Lease Asset Report? ❑Yes >�No
If yes, how frequent? ❑Monthly ❑Quarterly ❑Annually ❑Other
Attention:
Address:
City, State,Zip:
Telephone Number:
FAX Number:
E-Mail Address:
Rerem CO7 Pae 3 of 4
emirs informiku"•Pttk 8
Would you prefer to have your Leased Asset Report posted to your Premiere Page? ❑Yes ) No
Login:
Address:
PLEASE ADVISE LESSOR AT THE ADDRESS LISTED BELOW OF CHANGES IN THE INFORMATION PROVIDED ABOVE.
Please return this document along with all other required documents to:
Dell Financial Services L.L.C.
Public Segment Lease Administration
One Dell Way
RR3-56
Round Rock, TX 78682
Completed/Confirmed By:
Lessee: Lessee ocument S* Lessee Account -Payable Representative
By: ,,
Name: U Susan Alam s
Title:
Assistant City
Date: _ ((I(
a rti
A�*
1
by: * clry
AjDDDOy„� TC rrONM AND LEGALITY
nald P. GOnzales,A
CRYATTOM&
* H1
Page 4 of 4
enunt InfcmiaUo".Poetic