2025-07-08 Water labRemittance Address:24hr Customer Service: (800) 466-7873
28563 Network Place Tax ID Number: 80-0909020
a Xylem business Chicago, IL 60673
Sign and return this with your account number via fax to (724)-572-0210 or email to porenewal@xylem.com
AUTO RENEWAL: This agreement will automatically renew using the payment method selected below or (if
blank) as previously provided unless buyer expressly wishes to opt-out of this agreement. Evoqua Water
Technologies, LLC will notify you of any price changes to allow an opportunity to authorize additional funds if
required.( ) I DO NOT WISH TO AUTORENEW
Please choose one of the following payment options:
( )PLEASE AUTO-RENEW MY ACCOUNT WITH THE SAME PO REFERENCED ABOVE
( )VISA / MASTER CARD / AMEX:CIRCLE ONE PLEASE.If paying by credit card, an additional usage fee may apply per invoice.
EXP DATE:__________CARD#________________________________________NAME ON CARD:________________________________
**Please provide email where credit card invoice receipts need to be sent: ______________________________________________________
( )PURCHASE ORDER:Service will be performed at the estimated frequency above or sooner and an invoice referencing the
purchase order will be sent.
PO (# or authorized name if no purchasing system)
_________________________________________________________
EXPIRATION DATE:
_________________________________
To speak with your representative, contact Maliah McFarland via PH 832-295-8054 or maliah.mcfarland@xylem.com
_____________________________________________________________________________________
PRINT NAME / DATE PHONE NUMBER
_____________________________________________________________________________________
CUST SIGNATURE / TITLE EMAIL ADDRESS
IF TAX-EXEMPT, please provide a certificate issued to: Evoqua Water Technologies, LLC
Date: July 1, 2025 Net
Terms:N30 days
To:VICKIE THORMAHLEN Phone:(360) 740-1237
COUNTY OF LEWIS Fax:?
PUBLIC HEALTH BLDG Email:VICKIE.THORMAHLEN@LEWISCOUNTYWA.GOV
360 Nw North St
Chehalis,WA 98532-1925 Branch:043 Seattle 40576264
Reference: Acct: 0432010779 Current PO: 7060 Current Pricing Expires:
8/31/2025
>>> PLEASE NOTE: Completed Renewal letter or hard copy PO receipt required prior to expiration date referenced above <<<
Dear valued customer,
Thank you for being an Evoqua customer, as well as for allowing us to fulfill your water treatment needs. As your current purchase
order will run out of funds soon, we look forward to extending our current engagement. The prices listed below will apply for the
12 Month period immediately following the date above. If you do not currently issue blanket PO’s to Evoqua for the services we
provide, prices are subject to change without notice. Upon completion of this document, Evoqua Water Technologies LLC’s Terms
& Conditions will apply. The link is located at https://www.evoqua.com/en/about-us/terms-conditions-sale-products-
services.For additional services or labor not included here, please call for rates. The schedule below is based on the systems
current minimum annual service frequency.We appreciate your continued use of Evoqua’s water services.
THIS IS NOT AN INVOICE
Schedule of Services
Part Number Description Qty Frequency Unit Price Minimum
Yearly Total
W3TSP3011 PM CONTRACT RECURRING - PARTS & LABOR 1 12 Months $1,457.00 $1,457.00
W2T169711 FILTER CTRDG,10" 20UM CODE F GAC 1 3 Months $0.00 $0.00
W2T517576 CART 10" BB CODE F HIGH PURITY MIXE 1 3 Months $0.00 $0.00
W2T914668 CART 9.75" 1UM MB CDN PP 1 3 Months $0.00 $0.00
W3TSP4159 TRIP CHARGE PER VISIT 1 3 Months $300.00 $1,200.00
****A fuel/energy surcharge of $35.00 per service visit is in effect. A chemical surcharge based on tank size will be applied to each tank exchanged for SDI
and WWIX service visits. Surcharge pricing may change throughout the engagement period (subject to market conditions).Failure to provide a purchase
order for this renewal notice, will result in a $100 administration fee for the processing of an alternate form of payment**.
*For SDI customers; Tanks that are included in the exchange items listed above are leased and remain the property of Evoqua. Tanks will be exchanged
every six months or sooner (unless digitally monitored), per terms of the tank lease*.