PROCESSING AGREEMENT FORMProcessing Agreement • March 9th, 2017
PROPERTY OR PROJECT INFORMATION OFFICE USE ONLY 1. PROPERTY OWNER / PROJECT NAME: PERMIT NO. 2. PROJECT LOCATION / PROPERTY ADDRESS: CHECK # / AMOUNT ($): 3. CITY: 4. STATE: 5. ZIP CODE: PJA #:: MILPITAS ` 6. PROJECT DESCRIPTION: APPLICANT INFORMATION 7. NAME AND TITLE 8. COMPANY: 9. FEDERAL TAX ID / SOCIAL SERCURITY #: 10. APPLICANT MAILING ADDRESS: 11. CITY: 12. STATE: 13. ZIP CODE: 13. PHONE #: 14. FAX # 21. EMAIL ADDRESS: BILLING INFORMATION (IF DIFFERENT FROM ABOVE) Statements, requests for deposits or refunds shall be directed to Applicant identified in the Application Information section above unless stated otherwise below: 14. NAME AND TITLE 15. COMPANY: 16. FEDERAL TAX ID / SOCIAL SERCURITY #: 17. APPLICANT MAILING ADDRESS: 18. CITY: 19. STATE: 20. ZIP CODE: 21. PHONE #: 22. FAX # 23. EMAIL ADDRESS: Applicant agrees to pay all legal costs and consultant costs (including but not lim