HomeMy WebLinkAboutAdden 3DocuSign, Inc.
221 Main Street, Suite 1550
San Francisco, CA 94105
Offer Valid Through: Feb 21,
2022
Prepared By: Jennifer
Drouillard
Quote Number: Q-00730550
ORDER FORM
Address Information
Bill To: Ship To:
City of Renton City of Renton
1055 S Grady Way,
Renton, WA, 98057
United States
1055 S Grady Way,
Renton, WA, 98057
United States
Billing Contact Name: Shipping Contact Name:
Tien Akutagawa Tien Akutagawa
Billing Email Address:
takutagawa@rentonwa.gov
Shipping Email Address:
takutagawa@rentonwa.gov
Billing Phone:
425.430.6884
Shipping Phone:
425.430.6884
Order Details
Order Start Date: Feb 21, 2022 Payment Method: Check
Order End Date: Dec 4, 2022 Payment Terms: Net 30
Billing Frequency: Annual Currency: USD
Products
Product Name Start Date End Date Quantity Net Price
eSignature Business Pro Edition - Envelope Subs. Feb 21, 2022 Dec 4, 2022 500 $2,205.00
eSignature Advanced Workflows Addon - Envelope Subs. Feb 21, 2022 Dec 4, 2022 500 $1,102.50
Premier Support Feb 21, 2022 Dec 4, 2022 1 $496.12
Grand Total: $3,803.62
Product Details
eSignature Envelope Allowance: 500
CAG-21-283, Adden #3-22
Page 2 of 3
Overage/Usage Fees
eSignature Business Pro Edition - Envelope Subs. (Per Transaction): $5.80
Order Special Terms
Terms & Conditions
This Order Form is governed by the terms Master Services Agreement available online at:
https://www.docusign.com/company/terms-and-conditions/msa and the applicable Service
Schedule(s) and Attachments for the DocuSign Services described herein available online at
https://www.docusign.com/company/terms-and-conditions/msa-service-schedules.
Billing Information
Prices shown above do not include any state and local taxes that may apply. Any such taxes
are the responsibility of the Customer and will appear on the final Invoice.
Is the contracting entity exempt from sales tax?
Please select Yes or No: \tax1\
If yes, please send the required tax exemption documents immediately to
taxexempt@docusign.com.
Invoices for this order will be emailed automatically from invoicing@docusign.com. Please
make sure this email is on an approved setting or safe senders list so notifications do not go to
a junk folder or caught in a spam filter.
Purchase Order Information
Is a Purchase Order (PO) required for the purchase or payment of the products on this Order
Form?
Please select Yes or No: \por1\
If yes, please complete the following:
PO Number: \po1\
PO Amount: $\pa1\
Page 3 of 3
By signing this Agreement, I certify that I am authorized to sign on behalf of the
Customer and agree to the Terms and Conditions of this Order Form and any
documents incorporated herein.
Customer DocuSign,
Inc.
Signature:\si1\Signature:\si3\
Name:\na1\Name:\na3\
Job Title:\ti1\Job Title:\ti3\
Date:\ds1\Date:\ds3\
\\in2\Signature:
Email:
Young Yoon
IT Director
02/15/2022
yyoon@rentonwa.gov
INVOICE
DocuSign Inc.
Remittance slips can be emailed to remittance@docusign.com
Tax*-Taxation based on ‘Ship To’ address information.
For additional information, including answers to frequently asked billing questions, please visit our Billing Support site at:
https://www.docusign.com/support
Invoice Date:
Invoice #:
Payment Terms:
Due Date:
Account Name:
Feb 21, 2022
INV31376870
Net 30
Mar 23, 2022
City of Renton
Billing Account #:A00346886
Bill To: City of Renton
takutagawa@rentonwa.gov
1055 S Grady Way
Renton
Washington 98057
United States
Ship To:City of Renton
takutagawa@rentonwa.gov
1055 S Grady Way
Renton
Washington 98057
United States
PO Number Description Service Period Quantity Tax Amount Extended Price
eSignature Business Pro Edition - Envelope Subs.-
Envelope
02/05/2022-
02/20/2022 51 0.00 0.00
eSignature Business Pro Edition - Envelope Subs.-
Envelope Allowance -- Proration
02/21/2022-
12/04/2022 500 222.71 2,205.00
Premier Support-Premier Support -- Proration 02/21/2022-
12/04/2022 1 0.00 496.12
eSignature Advanced Workflows Addon - Envelope
Subs.-eSignature Advanced Workflows Addon -
Envelope Subs. -- Proration
02/21/2022-
12/04/2022 500 111.35 1,102.50
Subtotal:3,803.62
Tax*:334.06
Total:4,137.68
Currency:USD
TRANSACTIONS ASSOCIATED TO THIS INVOICE
Total Adjustments 0.00
Total Credits - 0.00
Total Payments - 0.00
Invoice Balance 4,137.68
Currency USD
*PLEASE NOTE THE NEW REMIT TO BANKING INFORMATION BELOW*
DocuSign Envelope ID: 0E82DDD4-4A64-4314-9F28-8BDF967B5B5ADocuSign Envelope ID: DC3997BD-D285-43C2-AB69-78A5E5263E90
INVOICE
DocuSign Inc.
Remittance slips can be emailed to remittance@docusign.com
Tax*-Taxation based on ‘Ship To’ address information.
For additional information, including answers to frequently asked billing questions, please visit our Billing Support site at:
https://www.docusign.com/support
Please remit electronic payments to:
JPMorgan Chase
New York, NY 10017
ACH Routing #: 322271627
Wire Routing #: 021000021
Account #: 623675136
Swift Code: CHASUS33
Please remit checks to:
DOCUSIGN INC Lockbox
P.O. Box 735445
Dallas, TX 75373-5445
For Courier Deposits (Fed EX, UPS, etc.):
JPMorgan Chase (TX1-0029)
Attn: DOCUSIGN INC Lockbox 735445
14800 Frye Road, 2nd Floor
Ft Worth, TX 76155
DocuSign Envelope ID: 0E82DDD4-4A64-4314-9F28-8BDF967B5B5ADocuSign Envelope ID: DC3997BD-D285-43C2-AB69-78A5E5263E90
INVOICE
DocuSign Inc.
Remittance slips can be emailed to remittance@docusign.com
Tax*-Taxation based on ‘Ship To’ address information.
For additional information, including answers to frequently asked billing questions, please visit our Billing Support site at:
https://www.docusign.com/support
Dear Valued Customer,
Please note: Our Lockbox Address has changed
These new payment instructions are now provided on your invoice. Please update your records
accordingly to ensure your payment is received and applied in a timely manner. This change
will be effective as of September 1, 2020.
Sincerely,
Angela Pope
Sr. Manager, Accounts Receivable
DocuSign, Inc.
DocuSign Envelope ID: 0E82DDD4-4A64-4314-9F28-8BDF967B5B5ADocuSign Envelope ID: DC3997BD-D285-43C2-AB69-78A5E5263E90