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Submission: On October 06 via automatic, source certstream-suspicious — Scanned from DE
Submission: On October 06 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 1 forms found in the DOM
<form action="" style="clear:both;">
<div style="text-align:center;">
<div style="display:inline-block;">
<div style="text-align:left;">
<span style="display:inline-block;width:100px;">Name:</span> <input type="text" id="name" name="name" style="text-align:left;padding-left:0;margin-left:0;" readonly=""><br>
<span style="display:inline-block;width:100px;">Address:</span>
<pre style="display:inline-block" id="address"></pre>
</div>
<section id="services" style="margin-top: 20px;">
<!--<input type="checkbox" id="creativeWork" name="creativeWork" disabled />-->
<fieldset>
<legend>Creative Work Services</legend>
<table>
<tbody>
<tr style="background-color:#00a0e3;color:#fff;">
<th></th>
<th>Service Name</th>
<th>Service Description</th>
<th>Quantity</th>
<th>Rate</th>
<th>Price</th>
</tr>
<tr>
<td><input type="checkbox" id="identityPackage" name="identityPackage" disabled=""></td>
<td>Identity Package</td>
<td>
<pre name="ipDesc" id="ipDesc">Logo design and files for business cards, letterheads, and envelopes.</pre>
</td>
<td><input type="text" id="ipQt" name="ipQt" value="" readonly=""></td>
<td><input type="text" id="ipRate" name="ipRate" value="" readonly=""></td>
<td><input type="text" id="ipPrice" name="ipPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="logoRefresh" name="logoRefresh" disabled=""></td>
<td>Logo Refresh</td>
<td>
<pre id="logoDesc" name="logoDesc">Logo design refresh</pre>
</td>
<td><input type="text" id="logoQt" name="logoQt" value="" readonly=""></td>
<td><input type="text" id="logoRate" name="logoRate" value="" readonly=""></td>
<td><input type="text" id="logoPrice" name="logoPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="postCardDesign" name="postCardDesign" disabled=""></td>
<td>Post Card Design</td>
<td>
<pre id="pcDesc" name="pcDesc">Post card design</pre>
</td>
<td><input type="text" id="pcQt" name="pcQt" value="" readonly=""></td>
<td><input type="text" id="pcRate" name="pcRate" value="" readonly=""></td>
<td><input type="text" id="pcPrice" name="pcPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="welcomeBrochure" name="welcomeBrochure" disabled=""></td>
<td>Welcome Brochure</td>
<td>
<pre id="wbDesc" name="wbDesc">Welcome brochure package</pre>
</td>
<td><input type="text" id="wbQt" name="wbQt" value="" readonly=""></td>
<td><input type="text" id="wbRate" name="wbRate" value="" readonly=""></td>
<td><input type="text" id="wbPrice" name="wbPrice" value="" readonly=""></td>
</tr>
<!--</tbody></table>
</fieldset>
<input type="checkbox" id="website" name="website" disabled />
<fieldset>
<legend>Website Design</legend>
<table><tbody>
<tr>
<th></th>
<th>Service Name</th>
<th>Service Description</th>
<th>Quantity</th>
<th>Rate</th>
<th>Price</th>
</tr>-->
<tr>
<td><input type="checkbox" id="mainsite" name="mainsite" disabled=""></td>
<td>Website - Mainsite</td>
<td>
<pre id="wmainDesc" name="wmainDesc" readonly=""></pre>
</td>
<td><input type="text" id="wmainQt" name="wmainQt" value="" readonly=""></td>
<td><input type="text" id="wmainRate" name="wmainRate" value="" readonly=""></td>
<td><input type="text" id="wmainPrice" name="wmainPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="microsite" name="microsite" disabled=""></td>
<td>Website - Microsite</td>
<td>
<pre id="wmicroDesc" name="wmicroDesc" readonly=""></pre>
</td>
<td><input type="text" id="wmicroQt" name="wmicroQt" value="" readonly=""></td>
<td><input type="text" id="wmicroRate" name="wmicroRate" value="" readonly=""></td>
<td><input type="text" id="wmicroPrice" name="wmicroPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="additionalPages" name="additionalPages" disabled=""></td>
<td>Website - Pages (Additional)</td>
<td>
<pre id="wpageDesc" name="wpageDesc" readonly=""></pre>
</td>
<td><input type="text" id="wpageQt" name="wpageQt" value="" readonly=""></td>
<td><input type="text" id="wpageRate" name="wpageRate" value="" readonly=""></td>
<td><input type="text" id="wpagePrice" name="wpagePrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="partialBuild" name="partialBuild" disabled=""></td>
<td>Website - Partial Build</td>
<td>
<pre id="wpartialDesc" name="wpartialDesc" readonly=""></pre>
</td>
<td><input type="text" id="wpartialQt" name="wpartialQt" value="" readonly=""></td>
<td><input type="text" id="wpartialRate" name="wpartialRate" value="" readonly=""></td>
<td><input type="text" id="wpartialPrice" name="wpartialPrice" value="" readonly=""></td>
</tr>
<!--</tbody></table>
</fieldset>
<input type="checkbox" id="videoPackage" name="videoPackage" disabled />
<fieldset>
<legend>Video Package</legend>
<table><tbody>
<tr>
<th></th>
<th>Service Name</th>
<th>Service Description</th>
<th>Quantity</th>
<th>Rate</th>
<th>Price</th>
</tr>-->
<tr>
<td><input type="checkbox" id="mediaPackage" name="mediaPackage" disabled=""></td>
<td>Media Package</td>
<td>
<pre id="mpDesc" name="mpDesc" readonly=""></pre>
</td>
<td><input type="text" id="mpQt" name="mpQt" value="" readonly=""></td>
<td><input type="text" id="mpRate" name="mpRate" value="" readonly=""></td>
<td><input type="text" id="mpPrice" name="mpPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="mediaAdditional" name="mediaAdditional" disabled=""></td>
<td>Videos - Additional</td>
<td>
<pre id="vaDesc" name="vaDesc" readonly=""></pre>
</td>
<td><input type="text" id="vaQt" name="vaQt" value="" readonly=""></td>
<td><input type="text" id="vaRate" name="vaRate" value="" readonly=""></td>
<td><input type="text" id="vaPrice" name="vaPrice" value="" readonly=""></td>
</tr>
<!--</tbody></table>
</fieldset>
<input type="checkbox" id="socialMedia" name="socialMedia" disabled />
<fieldset>
<legend>Social Media Services</legend>
<table><tbody>
<tr>
<th></th>
<th>Service Name</th>
<th>Service Description</th>
<th>Quantity</th>
<th>Rate</th>
<th>Price</th>
</tr>-->
<tr>
<td><input type="checkbox" id="facebook" name="facebook" disabled=""></td>
<td>Facebook Page</td>
<td>
<pre id="fbDesc" name="fbDesc" readonly=""></pre>
</td>
<td><input type="text" id="fbQt" name="fbQt" value="" readonly=""></td>
<td><input type="text" id="fbRate" name="fbRate" value="" readonly=""></td>
<td><input type="text" id="fbPrice" name="fbPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="googleplus" name="googleplus" disabled=""></td>
<td>Google+ Page</td>
<td>
<pre id="gpDesc" name="gpDesc" readonly=""></pre>
</td>
<td><input type="text" id="gpQt" name="gpQt" value="" readonly=""></td>
<td><input type="text" id="gpRate" name="gpRate" value="" readonly=""></td>
<td><input type="text" id="gpPrice" name="gpPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="twitter" name="twitter" disabled=""></td>
<td>Twitter Page</td>
<td>
<pre id="twitterDesc" name="twitterDesc" readonly=""></pre>
</td>
<td><input type="text" id="twitterQt" name="twitterQt" readonly=""></td>
<td><input type="text" id="twitterRate" name="twitterRate" value="" readonly=""></td>
<td><input type="text" id="twitterPrice" name="twitterPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="yelp" name="yelp" disabled=""></td>
<td>Yelp Page</td>
<td>
<pre id="yelpDesc" name="yelpDesc" readonly=""></pre>
</td>
<td><input type="text" id="yelpQt" name="yelpQt" value="" readonly=""></td>
<td><input type="text" id="yelpRate" name="yelpRate" value="" readonly=""></td>
<td><input type="text" id="yelpPrice" name="yelpPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="youtube" name="youtube" disabled=""></td>
<td>YouTube Page</td>
<td>
<pre id="ytDesc" name="ytDesc" readonly=""></pre>
</td>
<td><input type="text" id="ytQt" name="ytQt" value="" readonly=""></td>
<td><input type="text" id="ytRate" name="ytRate" value="" readonly=""></td>
<td><input type="text" id="ytPrice" name="ytPrice" value="" readonly=""></td>
</tr>
<!--</tbody></table>
</fieldset>
<input type="checkbox" id="websiteSoftware" name="websiteSoftware" disabled />
<fieldset>
<legend>RevEazy</legend>
<table><tbody>
<tr>
<th></th>
<th>Service Name</th>
<th>Service Description</th>
<th>Quantity</th>
<th>Rate</th>
<th>Price</th>
</tr>-->
<tr>
<td><input type="checkbox" id="revEazy" name="revEazy" disabled=""></td>
<td>RevEazy</td>
<td>
<pre id="revDesc" name="revDesc" readonly=""></pre>
</td>
<td><input type="text" id="revQt" name="revQt" value="" readonly=""></td>
<td><input type="text" id="revRate" name="revRate" value="" readonly=""></td>
<td><input type="text" id="revPrice" name="revPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="revEazyReduced" name="revEazyReduced" disabled=""></td>
<td>RevEazy (Reduced)</td>
<td>
<pre id="revredDesc" name="revredDesc" readonly=""></pre>
</td>
<td><input type="text" id="revredQt" name="revredQt" value="" readonly=""></td>
<td><input type="text" id="revredRate" name="revredRate" value="" readonly=""></td>
<td><input type="text" id="revredPrice" name="revredPrice" value="" readonly=""></td>
</tr>
<!--</tbody></table>
</fieldset>
<input type="checkbox" id="recurringMaintenance" name="recurringMaintenance" disabled />
<fieldset>
<legend>Maintenance</legend>
<table><tbody>
<tr>
<th></th>
<th>Service Name</th>
<th>Service Description</th>
<th>Quantity</th>
<th>Rate</th>
<th>Price</th>
</tr>-->
<tr>
<td><input type="checkbox" id="mainRecurring" name="mainRecurring" disabled=""></td>
<td>Main Site - Recurring Maintenance</td>
<td>
<pre id="mrDesc" name="mrDesc" readonly=""></pre>
</td>
<td><input type="text" id="mrQt" name="mrQt" value="" readonly=""></td>
<td><input type="text" id="mrRate" name="mrRate" value="" readonly=""></td>
<td><input type="text" id="mrPrice" name="mrPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="mainRecurringReduced" name="mainRecurringReduced" disabled=""></td>
<td>Main Site - Recurring Maintenance - Reduced</td>
<td>
<pre id="mrrDesc" name="mrrDesc" readonly=""></pre>
</td>
<td><input type="text" id="mrrQt" name="mrrQt" value="" readonly=""></td>
<td><input type="text" id="mrrRate" name="mrrRate" value="" readonly=""></td>
<td><input type="text" id="mrrPrice" name="mrrPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="microRecurring" name="microRecurring" disabled=""></td>
<td>Micro Site - Recurring Maintenance</td>
<td>
<pre id="mirDesc" name="mirDesc" readonly=""></pre>
</td>
<td><input type="text" id="mirQt" name="mirQt" value="" readonly=""></td>
<td><input type="text" id="mirRate" name="mirRate" value="" readonly=""></td>
<td><input type="text" id="mirPrice" name="mirPrice" value="" readonly=""></td>
</tr>
<tr>
<td><input type="checkbox" id="microRecurringReduced" name="microRecurringReduced" disabled=""></td>
<td>Micro Site - Recurring Maintenance - Reduced</td>
<td>
<pre id="mirrDesc" name="mirrDesc" readonly=""></pre>
</td>
<td><input type="text" id="mirrQt" name="mirrQt" value="" readonly=""></td>
<td><input type="text" id="mirrRate" name="mirrRate" value="" readonly=""></td>
<td><input type="text" id="mirrPrice" name="mirrPrice" value="" readonly=""></td>
</tr>
</tbody>
</table>
</fieldset>
</section>
<div style="text-align: right;">Total Cost: <input id="total" name="total" value="" readonly=""></div>
</div>
</div>
<h3>Payment Plan</h3>
<pre id="payment" name="payment" style="width:100%;white-space:pre-wrap;"></pre>
<div style="page-break-inside: avoid;">
<h3>Terms & Conditions</h3>
<p>By signing this work authorization, <span class="nameAgreement"></span> (located at <span class="addressAgreement"></span>) (you) agrees to the services, deliverables and terms set forth herein provided by DentalCMO LLC (located at 5252 N.
Edgewood Dr., Provo, UT 84604) (us, we): <strong>1. Services rendered.</strong> We will provide the services outlined in this authorization at the quoted prices. Requests above and beyond those detailed in this agreement may be considered
out-of-scope, and an amendment to this agreement may be recommended. <strong>2. Terms of payment.</strong> Payment of each invoice is due upon receipt. We reserve the right to break down payments if necessary. In the event payment is not made
within 30 days, we may charge a service fee of 2% per month to cover the manpower, interests, and other costs we pay for carrying overdue invoices. In addition, we reserve the right to stop work until payment is received. In the event that we
incur legal fees, costs, and disbursements in an effort to collect our invoices, in addition to the interest on the unpaid balance, you agree to reimburse us for all of these expenses and any other expenses incurred in collecting from you.
<strong>3. Indemnification for errors.</strong> We cannot be liable to you or any 3rd party for damages you attribute to us, including lost profits, lost savings, or any other incidental, consequential, or special damages, even if you are have
advised us of them. <strong>4. Copyright.</strong> Once your final payment in full has cleared, rights to the work we create as part of this agreement will transfer to you. We do reserve the right to use the work we have created to showcase our
business. <strong>5. Cancellation of plans.</strong> You have the right to modify, reject, cancel, or stop any and all plans or work in process. All such requests must be in writing by e-mail or hard copy. However, you agree to reimburse us for
all costs we incur prior to your change in instructions and indemnify and hold us harmless for any liability relating to such action. We agree to use our best efforts to minimize such costs and expenses. <strong>6. Terms.</strong> This
agreement shall become effective on the date listed in this document and shall continue until terminated by either party after reasonable notice is given. <strong>7. Governing laws and venue.</strong> This agreement shall be governed and
construed in accordance with the laws of the state of Utah venue will be 4th District Court in Provo, Utah. <strong>8. Representations and warranties.</strong> The signers of this agreement each individually represent and warrant that each has
full power and authority to enter into this agreement and bind themselves and/or their respective organizations to the terms herein. <strong>9. Agreement.</strong> This agreement incorporates all conversations, e-mail, and personal
correspondence. <strong>10. Serviceability.</strong> If any term or provision in this agreement shall be held to be invalid or unenforceable, the remainder of this agreement shall be not affected thereby.</p>
<h3 class="hidepdf">Sign Below</h3>
<div id="signature-pad" class="m-signature-pad hidepdf">
<div class="m-signature-pad--body">
<canvas></canvas>
</div>
<div class="m-signature-pad--footer">
<div class="description"><input type="text" id="signature" autocomplete="off" placeholder="Sign above or type signature here"></div>
<button type="button" class="button clear" data-action="clear">Clear</button>
<button type="button" class="button save" data-action="save">Save</button>
</div>
</div>
<button id="redoButton" type="button" class="button redo hidepdf" data-action="redo" style="display:none">Redo Signature</button>
<div style="display:block;width:100%;height:1px;"></div>
<div style="display: inline-block;width:32%">Email: <input type="text" id="email" name="email" readonly=""></div>
<div style="display: inline-block;width:32%" class="pdfonly"> Signature IP: <input type="text" id="ip" name="ip" readonly="">
</div>
<div style="display: inline-block;width:32%" class="pdfonly"> DentalCMO IP: <input type="text" id="adminip" name="adminip" readonly="">
</div>
<div style="display:block;width:100%;height:1px;"></div>
<button class="hidepdf">Send</button>
</div>
</form>Text Content
DentalCMO 5252 Edgewood Drive #365 Provo, UT 84604 (385) 203-7527 chris@dentalcmo.com http://www.dentalcmo.com Name: Address: Creative Work Services Service Name Service Description Quantity Rate Price Identity Package Logo design and files for business cards, letterheads, and envelopes. Logo Refresh Logo design refresh Post Card Design Post card design Welcome Brochure Welcome brochure package Website - Mainsite Website - Microsite Website - Pages (Additional) Website - Partial Build Media Package Videos - Additional Facebook Page Google+ Page Twitter Page Yelp Page YouTube Page RevEazy RevEazy (Reduced) Main Site - Recurring Maintenance Main Site - Recurring Maintenance - Reduced Micro Site - Recurring Maintenance Micro Site - Recurring Maintenance - Reduced Total Cost: PAYMENT PLAN TERMS & CONDITIONS By signing this work authorization, (located at ) (you) agrees to the services, deliverables and terms set forth herein provided by DentalCMO LLC (located at 5252 N. Edgewood Dr., Provo, UT 84604) (us, we): 1. Services rendered. We will provide the services outlined in this authorization at the quoted prices. Requests above and beyond those detailed in this agreement may be considered out-of-scope, and an amendment to this agreement may be recommended. 2. Terms of payment. Payment of each invoice is due upon receipt. We reserve the right to break down payments if necessary. In the event payment is not made within 30 days, we may charge a service fee of 2% per month to cover the manpower, interests, and other costs we pay for carrying overdue invoices. In addition, we reserve the right to stop work until payment is received. In the event that we incur legal fees, costs, and disbursements in an effort to collect our invoices, in addition to the interest on the unpaid balance, you agree to reimburse us for all of these expenses and any other expenses incurred in collecting from you. 3. Indemnification for errors. We cannot be liable to you or any 3rd party for damages you attribute to us, including lost profits, lost savings, or any other incidental, consequential, or special damages, even if you are have advised us of them. 4. Copyright. Once your final payment in full has cleared, rights to the work we create as part of this agreement will transfer to you. We do reserve the right to use the work we have created to showcase our business. 5. Cancellation of plans. You have the right to modify, reject, cancel, or stop any and all plans or work in process. All such requests must be in writing by e-mail or hard copy. However, you agree to reimburse us for all costs we incur prior to your change in instructions and indemnify and hold us harmless for any liability relating to such action. We agree to use our best efforts to minimize such costs and expenses. 6. Terms. This agreement shall become effective on the date listed in this document and shall continue until terminated by either party after reasonable notice is given. 7. Governing laws and venue. This agreement shall be governed and construed in accordance with the laws of the state of Utah venue will be 4th District Court in Provo, Utah. 8. Representations and warranties. The signers of this agreement each individually represent and warrant that each has full power and authority to enter into this agreement and bind themselves and/or their respective organizations to the terms herein. 9. Agreement. This agreement incorporates all conversations, e-mail, and personal correspondence. 10. Serviceability. If any term or provision in this agreement shall be held to be invalid or unenforceable, the remainder of this agreement shall be not affected thereby. SIGN BELOW Clear Save Redo Signature Email: Signature IP: DentalCMO IP: Send Your agreement has been emailed to you successfully. There was an error sending the agreement.