Finance Committee - Agenda - 2/21/2018 - P210

This order is subject to the Standard Terms and Conditions of Sale — Xylem Americas effective on the date the
order is accepted which terms are available at http:/Awww.xyleminc com/en-us/Pages/terms-conditions-of-sale aspx
and incorporated herein by reference and made a part of the agreement between the parties.

A signed copy of this Quote is acceptable as a binding contract.

Purchase Order: Please make purchase orders out to: Xjl/em Water Solutions USA, Inc.

Proposal! Acceptance:

Name (Please Print):

Signature:

Purchase Order #:

Date:

BILL TO:
Company/Utility:

Address:

City/State/Zip:

Attention:

Phone:

Email:

Fax:

SHIP TO:
Company/Utility:

Address:

City/State/Zip:

Attention:

Phone.

Email:

Fax:

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a xytem brand
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