Printing Tenders

Details: Description Quotation Ctrl #: 25-01-002 Request For Quotation Procurement Of Meals, Snacks And Accommodation For The (phase Ii) Institutionalization And Implementation Of Improving School Heads Aptitude And Proficiency For Excellence (i-shape) Program Name Address Please Qoute Your Lowest Price On The Item/s Listed, Subject To The Conditions Stated Below, Stating The Shortest Time Of Delivery And Submit Byour Quotation Duly Signed By Your Representative And Placed In A Sealed Envelope On Or Before10:00am Of January 13, 2025 At The Office Of The Bac Chairperson. Quotations Submitted Beyond This Date And Time Will Not Be Any More Accepted. Meilrose B. Peralta, Edd, Cese Assistant Schools Division Superintendent Conditions: Bac Chairman 1 All Entries Must Be Filled Up. 2 Delivery Period Is On February 12-14, 2025. 3 Warranty Shall Be For A Period Of Six (6) Months For Supplies And Materials, One (1) Year For Equipment, From Date Of Acceptance By The Procuring Entity. 4 Price Validity Shall Be For A Period Of 90 Calendar Days. 5 Quotation That Exceeds The Total Approved Budget For The Contract (abc) Shall Be Rejected. 6 The Awarding Of Contract Shall Be Per Item Basis. 7 Quotation Forms Must Be Accompanied With A Valid Mayor's/business Permit, Dti Registration, Updated Philgeps Certificate Of Registration, Tax Clearance, Income/business Tax Return And Omnibus Sworn Statement (oss). Item No. Item Description Brand Qty Unit Unit Cost Total Price Procurement Of Meals, Snacks And Accommodation For The (phase Ii) Institutionalization And Implementation Of Improving School Heads Aptitude And Proficiency For Excellence (i-shape) Program Phase Ii: I-shape Training 1 Food And Hotel Accommodation (9meals And 6snacks) 360 Pax (3) Breakfast - 6:30am (3) Am Snacks - 9:00am (3) Lunch - 11:30am (3) Pm Snacks - 3:00pm (3) Dinner - 6:00pm Date Of Training: February 12-14, 2025 (3 Days) Specification Of Food: *halal *with Variety Of Fruits *with Overflowing Coffee Details Of Menu To Be Served For The Whole Duration Shall Be Attached Approve Budget For Contract (abc) 648,000.00 After Having Carefully Read And Accepted Your Conditions. I/we Qoute You On The Item At Prices Noted Above. Please Check: Printed Name/signature Vat Non-vat Tel. No./cellphone No. Email Address Tin

Details: Description Request For Quotation Please Quote Your Price On The Job/item Listed Below, Subject To The Specification And Terms And Conditions Provided Herein, Stating The Shortest Time Of Delivery And Submit Your Quotation In The Bid Box Located At The Procurement Section, National Irrigation Administration, Regional Office 6, Tacas, Jaro, Iloilo City, Duly Signed By Your Representative, Not Later Than 5:00 P.m. Of January 15, 2025. Failure To Observe Any Of The Herein Terms & Conditions Shall Be At The Risk Of The Bidder Concerned. (sgd) Angeles A. Pahayahay Bac Chairman □ 1. All Entries Must Be Printed; □ 2. Bidders Must Submit Philgeps Registration No. □ 3. Place This Rfq In A Sealed Envelope And Type The Following Details On The Face Of The Envelope; Your Company Name Pr No. Philgeps Reference No. □ 4. Delivery Period Must Be At Least Within Seven (7) Calendar Days Upon Receipt Of P.o. Otherwise Bidder Should Specify/indicate Delivery Date; □ 5. Item/s Delivered Must Have Warranties For Unit Replacements, Parts, Labor Or Other Services; □ 6. Price Validity Shall Be For A Period Of Three (3) Months; □ 7 Quoted Prices Must Be Inclusive Of Taxes, And Other Charges Or Fees And Shall Not Exceed The Approved Budget For The Contract (abc); □ 8. Transaction With Nia-jrmpii Shall Mean Compliance By The Winning Bidder With The Bid And Delivery Requirements Before The Issuance Of Check Payment; □ 9. Failure To Comply With These Conditions Shall Mean Disqualification Of Your Bid/proposal; Item No. Brand/model Warranty (if Applicable) Quantity Unit Unit Price 1. Labor Job: 1 Set Sign And Seal Of Architectural Plans And Application For Building Permit And Occupancy Permit Form 2. Labor Job: 1 Set Sign And Seal Of Electrical Plans And Electrical Permit Form 3. Labor Job: 1 Set Sign And Seal Of Structural Plans And Application For Buliding Permit And Occupancy Permit Form 4. Labor Job: 1 Set Sign And Seal Of Plumbing Plans And Plumbing Permit Form 5. Labor Job: 1 Set Sign And Seal Of Mechanical Plans And Mechanical Permit Form *****nothing As Follows***** Note: Subject To 5% Vat & 2% Ewt/ Cwt Deduction As Per Ra9337 Total Bid Price In Words And Figures: After Having Carefully Read And Accepted The Attached Terms And Conditions, We Are Submitting The Above Mentioned Price Quotation.

Details: Description San Pablo City Water District San Pablo City Telefax: (049) 503-0075 Email Address: Bac@spcwd.org.ph Request For Price Quotation Agd - 099 - 0 January 10, 2025 Contract No. 2025-003 Reference Pr No. : 12534 Date : 1/09/2025 Supplier : Address : Tin No. : Sealed Proposal For The Following Item(s) Must Be Received By The San Pablo City Water District Not Later Than : Date : January 16, 2025 Time : 2:00 P.m. Note: Please Re-fax This Form With Signature Stating The Reason If Not Participating. Item No. Description Qty. Unit Cost Total Approved Budget 1 Ci Dresser Coupling 8" Black - For Pvc 5 Pcs. 32,500.00 2 Ci Flange Adaptor 8" Black - For Pvc 4 Pcs. 36,000.00 68,500.00 Bid Amounts Must Be Inclusive Of Applicable Taxes (vat/non-vat) Note: Please Provide The Required Informations. Terms Of Payment : 30 Days Processing Delivery Period : 10 Days Warranty : Price Validity : Conditions: 1. Delivery Should Strictly Be Within The Prescribed Delivery Period Indicated In The Purchase Order. 2. Advance Notice Shall Be Given To Spcwd Should Such Delivery Will Not Be Made Possible. 3. Subject To Withholding Of Retention Money Or Special Bank Guarantee Equivalent To Five Percent (5%) Of The Total Contract Price The San Pablo City Water District Reserves The Right To Reject Any Or All Bids And To Accept Bids As May Be Considered Advantageous To The District. Maria Lourdes E. Dwiggins Arch. Mario A. Bondad Supervising Materials Planning Officer Bac Chairman After Having Carefully Read And Accepted Your General Conditions, I/we Quote You On The Item At Prices Noted Above. To Be Filled Up By The Supplier Quoted By: Tel No. ____________________ Fax No. ___________________ ___________ Cellphone No. ______________ Signature Over Printed Name Date E-mail Address _____________ San Pablo City Water District San Pablo City Telefax: (049) 503-0075 E-mail : Spcwd_bac@yahoo.com E-mail : Bac@spcwd.org.ph Eligibility Requirements For Bidders Contract No. 2025-003 Submit The Following Requirements: 1- Valid Business Or Mayor's Permit 2025 2- Dti Or Sec Registration Certificate 3- 2303 Bir Registration Certificate 4- Registered In Philgeps Arch. Mario A. Bondad Bac Chairman Note: All Interested Bidder : Call (049)503-0075 - Lowest Bidder Must Submit A Sample / Photo.

Details: Description Request For Quotation 13 January 2025 Date The Bureau Of Customs Port Of Cebu, Through Its Bids And Awards Committee, Hereby Invites All Interested Suppliers And Distributors, To Quote Their Price On The Item/s Listed Below, Subject To The Terms And Conditions Specified Herein, And Submit The Quotation Duly Signed By Their Authorized Representatives Not Later Than 17th January 2025 (friday). Name Of Project Procurement Of Office Equipment For Ciis And Ess Offices Location Port Of Cebu, Cebu City Approved Budget One Hundred Sixty-five Thousand Eighty Pesos. (php 165,080.00) Mode Of Procurement Small Value Procurement General Conditions The Terms And Conditions Are As Follows: 1. Bidders Shall Provide Correct And Accurate Information Required In This Form. 2. Price Quotation/s Must Be Valid For A Period Of Thirty (30) Calendar Days From The Date Of Submission. 3. Price Quotation/s To Be Denominated In Philippine Peso Shall Include All Taxes, Duties And/or Levies Payable. 4. Award Of Contract Shall Be Made To The Lowest Quotation Which Complies With The Technical Specifications, And Other Terms And Conditions Stated Herein. 5. Any Interlineations, Erasures, Or Overwriting Shall Be Valid Only If They Are Signed Or Initiated By You Or Any Of Your Authorized Representative/s. 6. All Items Must Be Delivered At The Bureau Of Customs Port Of Cebu. Please Indicate Delivery Charge, If Any. 7. The Bureau Of Customs Reserves The Right To Conduct Actual Examination Or Inspection With The Item/s To Determine Conformity With The Technical Specifications And Requirements. 8. The Term Of Payment Is Through Check Payment, Subject To Withholding Tax (bir Form 2306 & 2307). For Any Clarification, Please Contact Ms. Maria Carla L. Jucutan Administrative Aide Iv At 0928-700-6397 Or Mcjucutan.boc@gmail.com. ____________________ (date) The Chairperson Bids And Awards Committee Administrative Division Bureau Of Customs Port Of Cebu Cebu City Sir / Madam: After Having Read And Accepted The Terms And Condition/s, I/we Submit Our Quotation For The Item/s As Follows: Description Quantity Unit Unit Price Total 1 Office Equipment Desktop 3 Printer With Scanner 3 ***nothing Follows*** T O T A L Very Truly Yours, _________________________________ ______________________________ Name And Signature Position Name Of Business Establishment: ______________________________________________ Address: __________________________________________________________________ Contract No: _______________________________________________________________ • Attention: Ms. Maria Carla L. Jucutan (admin Division/osm) • Please Contact Through: 0928-700-6397 Or Mcjucutan.boc@gmail.com • Note: Please Include Updated Mayor’s Business Permit And Philgeps Certificate And Omnibus Sworn Statement

Details: Description Republic Of The Philippines Department Of Public Works And Highways Cagayan 2nd District Engineering Office Abulug, Cagayan, Region Ii Procuring Entity: Dpwh-cagayan 2nd Deo P.r. No.: 2025-01-001 Standard Form/title: Small Value Procurement (request For Quotation) P.r. Date: 1/2/2025 Revised On: Office/end User: Administrative Section Company Name: Address: Tel No./ Fax No: T.i.n: Please Quote Your Lowest Price On The Item(s) Listed, Subject To The Terms And Conditions Stated Below And Submit Your Quotation Duly Signed By Your Representative Not Later Than 10:00 Am Of January 20, 2025 To Procurement Unit, Dpwh-cagayan 2nd District Engineering Office, Libertad, Abulug, Cagayan And Will Opened On The Same Day At 10:30 Am Terms And Conditions: 1 All Entries Must Be Type Written Or Legibly Written. 2 Delivery Period Within 30 Working Days Upon Receipt Of The Approved Funded Purchase/work Order. Administrative Penalties Pursuant To Sec. 69 Of The Revised Irr-ra9184 Shall Be Imposed For Non-delivery Without Valid Reason. 3 Warranty Shall Be For A Minimum Of Three (3) Months For Supplies And Jesselito D. Bassig Materials; One (1) Year For Equipment From Date Or Acceptance By The End Engineer Iii User. Bac - Chairperson 4 Price Validity Shall Be For A Period Of 30 Calendar Days. 5 Philgeps Registration Certificate / Mayor's Permit / Omnibus Sworn Statement /income Tax Return Shall Be Attached Upon Submission Of The Quotation. 6 Please Indicate The Brand For Each Items Being Offered 7 The Approved Budget Ceiling For This Procurement Is Php 348,800.00 Item No Item & Description Qty Unit Unit Price Total Price I Rubber Flooring Matting, 2 Yards X 22 Yards X 3mm, Color Black, Coin Design -28- Pcs Ii Rubber Flooring Matting, 2 Yards X 22 Yards X 3mm, Color Red, Coin Design -4- Pcs Xxx Total Brand And Model: Warranty: Delivery Period: Price Validity: After Having Carefully Read And Accepted Your General Conditions, I/we Quote On The Item(s) At Prices Note Above. If The Space For Delivery Period, Warranty And Price Validity Are Left Blank, It Means That I Concur With The Terms And Conditions Specified By Dpwh. Printed Name / Signature / Date Tel. No. Cp. No. & Email Address

Details: Description Standard Form Number: Sf-good-60 Revised On: May 24, 2004 Request For Quotation Date: January 14, 2025 Quotation No.: 25-01-010 Business Name: Address: Owner: Please Quote Your Lowest Price On The Item/s Listed Below, Subject To The General Conditions On The Last Page, Stating The Shortest Time Of Delivery And Submit Your Quotation Duly Signed By Your Representative Not Later Than In The Return Envelope Attached Herewith. Gina Q. Tarog Cid Chief Chairperson, Deped, Sor. - Bids And Awards Committee Note: 1. All Entries Must Be Typewritten 2. Delivery Period Within Ten (10) Calendar Days 3. Warranty Shall Be For A Period Of Six (6) Months For Supplies & Materials, One (1) Year For Equipment, From Date Of Acceptance By The Procuring Entity 4. Price Validityshall Be For A Period Of Thirty (30) Calendar Days 5. Philgeps Registration Certificate For Php 500,000.00 Above Projects And Philgeps Registration No. For Below Php 500,000.00 And Mayors Permit, Dti Registration, Latest Income Tax Return And Omnibus Sworn Statement Shall Be Attached Upon Submission Of The Quotation Please Check: __/___ Philgeps Certification ___/______ Dti Certificate _______/__ Mayors Permit _______/__ Income Tax Return _______/____ Omnibus Sworn Statement 6. Bidders Shall Submit Original Brochures Showing Certifications Of The Product Being Offered. Item No. Item & Description Qty. Unit Abc Unit Price Total Unit Cost Total Provision Of Catering Services On The Conduct Of The Division Orientation On Program To Institutionalize Mertocracy And Excellence On Humna Resource Management (prime-hrm) 1 Meals (2 Snacks And 1 Lunch) 220 Pax 600.00 132,000.00 Am Snacks: Potato Salad, Chiffon Cake, Coffee/milo And Bottled Water, Lunch: Steamed Rice, Baby Back Ribs, Seafoods Sinigang, Bottled Water And Mixed Fruits, Pm Snacks: Cheese Cake, Softdrinks And Cheesy Spaghetti **with Free Flowing Coffee, Milo And Mineral Water X-x-x-x-x-x-x-x Total 132,000.00 Brand And Model: Delivery Period: Warranty: Price Validity: After Having Carefully Read And Accepted Your General Conditions, I/we Quote You On The Item At Prices Noted Above. Printed Name/signature Tel.no./cellphone No. Email Address Date

Details: Description City Government Of La Carlota Standard Form Number: Sf-good-59 Revised On: May 24, 2004 Standard Form Title: Request For Quotation Date: ______________ Quotation No.________ Company Name Address Please Quote Your Lowest Price On The Item/s Listed Below, Subject To The General Conditions On The Last Page, Starting The Shortest Time Of Delivery And Submit Your Quotation Duly Signed By Your Representative Not Later Than _______________________________________ In The Return Envelope Attached Herewith. (sgd.) Rommel R. Sabig City Health Officer/bac Chairman Note: 1. All Entries Must Be Typewritten 2. Delivery Period Within _____________ Calendar Days. 3. Warranty Shall Be For A Period Of Six(6) Months For Supplies & Materials, One (1) Year For Equipment, From Date Of Acceptance By The Procuring Entity. 4. Price Validity Shall Be For A Period Of _____________ Calendar Days. 5. G-eps Registration Certificate Shall Be Attached Upon Submission Of The Quotation. 6. Bidders Shall Submit Original Brochures Showing Certificatyions Of The Product Being Offered. Item No. Item & Description Qty. Unit Price 1 Double Deck Bed 2 Pcs P 2 File Cabinet 4 Pcs 3 Emergency Light 5 Pcs 4 Water Dispenser 1 Pc 5 Stainless Sink W/ Cabinet 1 Pc 6 Curtain Rods 5 Pcs 7 Curtains 4 Set 8 5 Cu.ft. Refrigerator 1 Pc 9 Office Table 1 Pc 10 Folding Table 1 Pc 11 2 Hp Window Type Aircon 1 Pc 12 Brother Btd60 Ink (black) 10 Pcs 13 Brother Bt5000 Ink (magenta) 5 Pcs 14 Brother Bt5000 Ink (cyan) 5 Pcs 15 Brother Bt5000 Ink (yellow) 5 Pcs 16 Long Bond Paper Sub. 20 30 Reams 17 Short Bond Paper Sub. 20 30 Reams 18 Keyboard & Mouse (wireless) 2 Pcs X-x-x-x-x Brand And Model : ________________________ Delivery Period : ________________________ Warranty : ________________________ Price Validity : ________________________ Name Of The Procuring Entity Project Reference Number Name Of The Project Location Of The Project After Having Carefully Read And Accepted Your General Conditions, I/we Quote You On The Item At Prices Noted Above. _________________________ Printed Name / Signature _________________________ Tel. No. / Cellphone No. ________________________ Date

Details: Description Republic Of The Philippines Vet Government Of Ormoc City P.r. No.: 250254 Bids And Awards Committee Quotation No.: 255721-3151 Ormoc City Philgeps No.: Standard Form Title: Request For Quotation Please Quote Your Lowest Price On The Item/s Listed Below, Subject To The General Conditions On The Last Page, Stating The Shortest Time Of Delivery And Submit Your Quotation Duly Signed By You Or Your Authorized Representative Not Later Than _______ _______________________. (sgd) Katheryn A. Solaña Procurement Officer Note: (1) All Entries Must Be Typewritten Or Legibly Written. Of Acceptance By The End-user. (4) Price Validity Shall Be For A Period Of (2) Delivery Period Within 15 C.d. Upon Receipt Of The Sixty (60) Days. (5) G-eps Reg No., Mayors Permit, Dti/sec, And For Abc's Above Approved Funded Purchase Order (p.o.). Administrative 500k - Itr & Omnibus Sworn Statement Shall Be Attached Upon Submission Penalties Pursuant To Sec. 69 Of The Revised Irr-ra 9184 Shall (6) Bidders Shall Submit Original Brochures Showing Certifications Of Be For A Minimum For Non-delivery Without Valid Reason. The Products If Applicable. (7) The Approved Budget Ceiling For This (3) Warranty Shall Be For A Period Of Three (3) Months Of Procurement Is (amount Indicated Below) Supplies & Materials, One (1) Year For Equipment, From Date Php 250,000.00 Activities Schedule From To 1 Issuance Of Canvass Tuesday January 21, 2025 Friday January 24, 2025 2 Submission Of Canvass Monday January 27, 2025 10:00 Am 3 Opening Of Canvass Monday January 27, 2025 2:00 Pm # Item And Description Qty Unit Cost Total 1 Dog Food 100 Sack - 20 Kgs. Sack, For Adult - Crude Protein - Minimum - 20% - Crude Fat - Minimum - 10% - Crude Fiber - Maximum - 5% - Moisture - Maximum - 10% - Expiry Date Not Earlier Than January 2026 -x-x-x-x-x-x-x- Nothing Follows -x-x-x-x-x-x-x- Grand Total >>> * Brand And Model : Warranty : Delivery Period : Price Validity : After Having Carefully Read And Accepted Your Conditions, I/we Quote You On The Item At Prices Noted Above And Hereby Commit To Deliver The Same If Adjudged To Have The Lowest And Responsive Quotation. Business Name 2025-01-250254 Printed Name/signature/date

Details: Description Republic Of The Philippines Province Of Palawan Municipality Of El Nido Name Of Procuring Entity: Pr No. 2025-01-0031 Municipal Government Of El Nido Rfq No. 2025-0031 Sef- Del Norte Date: 21-jan-25 Office/end-user: El Nido Del Norte Company Name: Adress: Business Permit No.: Tin No.: Philgeps Reg. No: Please Quote Your Lowest Price For The Requirements Listed Hereunder Subject To The Terms And Conditions Stated Below And Submit To This Office Duly Signed: Terms And Conditions: 1. Bidders Shall Provide Correct And Accurate Information In This Form. 2. Bidders May Quote For Any Or All Of The Items. 3. Price Quotation(s) Must Be Valid For A Period Of 60 Calenday Days From The Date Of Submission. 4. Price Quotation(s) To Be Denominated In Philippine Peso Shall Include All Taxes, Duties And/or Levies Payable. 5. Quotations Exceeding The Approved Budget For The Contract (abc) Shall Be Rejected. 6. Award Of Contract Shall Be Made To The Lowest Quotation(for Goods) Or The Highest Rated Offer (for Consulting Service) Which Complies With The Minimum Technical Specifications And Other Terms And Conditions Stated Herein. 7. Any Interlineations, Erasures Or Overwriting Shall Be Valid Only If They Are Signed Or Initialed By The Supplier Or Its Authorized Representatives. 8. The Item(s) Shall Be Delivered Within 2 Calendar Days From Receipt Of Purchase Order (po). 9. The Mun. Government Of El Nido Shall Have The Right To Inspect And/or To Test The Goods To Confirm Their Conformity To The Technical Specifications. 10. Liquidated Damages Equivalent Of One-tenth Of One Percent (.001%) Of The Value Of The Goods Not Delivered Within The Prescribed Delivery Period Shall Be Imposed Per Day Of Delay.the Mun. Government Shall Rescind The Contract Once The Cumulative Amount Of Liquidated Damages Reaches Ten Percent (10%) Of The Amount Of The Contract, Without Prejudice To Other Courses Of Action And Remedies Open To It. (signed) Approved Budget For The Contract: "raul B. Maximo Bac Chairman" ₱200,000.00 Item No. Unit Description Abc/item Quantity Unit Price Total Price 1. Unit Hire,bus Hire,el Nido-narra 50,000.00 2 - 2. Unit Hire,bus Hire,narra-el Nido 50,000.00 2 - Total - Warranty: _____________________________ Price Validity: ___________________________ After Having Carefully Read And Accepted Your General Conditions, I/we Quote On The Item(s) At Prices Noted Above. Printed Name/signature/date Tel. No./cellphone No.

Details: Description ** Please Note That It Is Required To Specify The Brand, Or Model, Or Technical Specifications Of The Product/item. For Items Without Brands (e.g. Sand, Gravel, Nails, Walis Tambo, Etc… ), Please Write The Word “comply”. Item No. Total Abc (in Php) Unit Qty Peza-bcez Specifications Bidder’s Offer (tech. Spec/ Model No., If Applicable) Unit Price (php) Total Price (php) Comprehensive General Pest Control Services For Cy 2025 (bcez Premises And Staff House) 1 52,965 Lot 1 Comprehensive General Pest Control Services (bcez Premises) Particulars / Specifications 1. Flying And Crawling Insects Program Which Includes Surface Spraying And Misting 2. Rat And Mice Control Program Which Includes Trapping And Baiting Of Rodents/ Mice. 3. Larvae Control Program - Prevention Hatching Of Eggs 4. Fogging And Misting Application Schedule & Frequency Of Service: Monthly Monitoring With Quarterly Comprehensive Service Areas Covered: Bcez Admin Bldg., Utility Bldg. (warehouse, Fitness Room, Fire Control Unit), 1m Gallon Tank Area, Stp Building And Guard House @ Gate 1 Duration: Cy 2025 2 26,400 Lot 1 Termite Control Program With Monthly Comprehensive General Pest Control Services At Staff House Particulars / Specifications 1. Termite Control Program - One-time Treatment With Quarterly Maintenance And Monthly Monitoring. 2. Flying And Crawling Insects Program Which Includes Surface Spraying And Misting 3. Rat And Mice Control Program Which Includes Trapping And Baiting Of Rodents/ Mice. 4. Larvae Control Program - Prevention Hatching Of Eggs Schedule And Frequency Of Service: Termite Control Program - One Time Treatment With Quarterly Maintenance And Monthly Monitoring. Monthly Comprehensive Pest Control Service Areas Covered: Staff House Duration: Cy 2025 Notes: 1. Pest Control To Be Scheduled Monthly. 2. Shoulder All Labor, Materials And Other Pest Control Facilities. 3. Chemicals To Be Used Are Safe And Environment Friendly, Fda Approved Chemicals 4. Provide A Copy Of Service Acknowledgement Report After Each Service. 5. Payment Shall Be Based On The Actual Services Rendered. Inclusive Of All Applicable Fees And Other Charges __________________________________________ ____________ Printed Name And Signature Of Authorized Representative Date Bidder/supplier’s Information: Company Name Address: Tel/fax No. Email Address: _______________________________________ Name And Signature Of Canvass