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Quotation Date: 318/2010 <br />Agreed to this day of <br />Buyer <br />By <br />Print Name <br />Inquiry Number: 10405 <br />By <br />Authorized Signature <br />Address <br />Is this purchase tax exempt? Yes_ No_ <br />if YES, attach Sales Tax Exemption Certificate. Failure to provide <br />tax exempt certiTicate prior to shipment wiil result in 6uyer being <br />responsible for all applicable taxes. <br />Page 5 of 5 <br />Agreed to this day of <br />at Lenexa, KS. <br />SMITH & LOVELESS, INC. <br />By <br />Authorized Signature <br />Prepared by <br />Sales Representative <br />NOTE: The Sales Representative is not an agent or <br />employee of Selier and is not authorized to enter into any <br />agreement on Seller's behaif or to bind Seiler in any way. <br /> <br />