ORDER FORM - ENTERPRISE SaaS - STATE OF WASHINGTON
| Provider | [PROVIDER LEGAL NAME] |
| Customer | [CUSTOMER LEGAL NAME] |
| Product | [PRODUCT NAME] |
| Term | [X] months/years |
| Fees | $[AMOUNT] |
Payment: Net [30] days. Washington sales tax: 6.5% state + local.
Data Breach: RCW 19.255.010 et seq.
Privacy: Washington Privacy Act; My Health My Data Act.
Venue: [King/Pierce/Snohomish] County, Washington.
SIGNATURES
Provider: _________________ Date: _______
Customer: _________________ Date: _______