Legal / Order Form
Brass Acre Order Form
Governed by the Brass Acre Master Subscription Agreement v1.1, posted at brassacre.com/legal/msa
Working draft, prepared for attorney review before launch.
Order Form number: ___________ Quote number: __________ Date: ___________
| Item | Entry |
|---|---|
| Agency legal name | |
| Billing address | |
| Billing contact, email and phone | |
| Purchase order number (if used) | |
| State whose law applies (if not California) | |
| Number of Stations | |
| Package | [ ] Core Four [ ] Full Acre [ ] Individual products (list below) |
| Individual products | |
| Reserved products (price locked, billed from release) | |
| Annual fee, Year 1 | $ |
| One time onboarding fee | $ |
| Term | [ ] 1 year, renews yearly, 4% cap [ ] 3 years at 10% off, price locked [ ] 3 years prepaid |
| Subscription Start Date | |
| Records covered | [ ] Patient care records (Exhibit D applies) [ ] Criminal justice information (Exhibit E applies) |
| Founding Agency | [ ] Yes, Exhibit F applies [ ] No |
| Special terms | |
| Sales tax | Added where the law requires unless a valid exemption certificate is on file |
By signing, each party agrees to this Order Form and to the Master Subscription Agreement named above. Signatures may be electronic.
Brass Acre: Ignis Public Safety Group, LLC, doing business as Brass Acre
Signature: _____________________ Name: ____________________ Title: ____________________ Date: _________
Agency
Signature: _____________________ Name: ____________________ Title: ____________________ Date: _________