Packet: Tiffin Regular City Council Meeting (07/07/2026)

Page 5 of 12 11. CUSTOMER BILLING INFORMATION: Billing Contact: ____________________________________________________ Title: ______________________________ Billing Address: ________________________________________________________________________________________________________ Office Phone: ________________________________________ Cell: ________________________________________________ Email: __________________________________________ PO #: __________________________________ Tax Exempt ID # (required): __________________________________ Note: If a tax-exempt number is not provided, a 10% service increase will be added to the yearly invoice. 12. ACCEPTANCE: The effective date of this Agreement is listed below. Authorized representatives of Customer and iWorQ have read the agreement and agree and accept all the terms. Signature: ________________________________________ Effective Date: ___________________________________ Printed Name: ____________________________________ Title: ____________________________________________ Office Phone: ________________________________________ Cell: ________________________________________________ Unless otherwise stated, Service Period starts the first day of the month after signature and Effective Date. Org ID: 29109 iWorQ Systems Deal ID: 119745 P.O. Box 3784, Logan, UT 84323