WQI DIGITAL PROGRAM AGREEMENT / DIGITAL PROPOSAL REQUEST

Please submit the below information to trigger a digital agreement/addendum/proposal to be sent to your customer for your recent digital sale. The agreement will be sent from DigitalAgreements@ecolab.com.

This form is primarily used for ECOLAB3D Water Quality Intelligence. If you have sold a different digital product, please be specific in the notes.

Ensure that your customer has accepted the digital T&Cs within WQI.

For any questions, please email DigitalAgreements@ecolab.com.

Your Name: *

Your Email Address: *

Division: *

Light SBU: *

Heavy SBU: *

Division Selected? *

Yes

District: *

Region: *

Type of Sale: *

Site-Level

Enterprise-Level (10+ sites submitted by CAM)

Submit a spreadsheet of site locations using this template.

Site Location File: *

Customer Information

Account Name: *

Sold-To Number: *

Ship-To Number: *

Account Address: *

Account City: *

Account State: *

Account Zip Code: *

Account Country: *

Additional Customer Location?

Yes

Ship-To Number: *

Account Address: *

Account City: *

Account State: *

Account Zip Code: *

Account Country: *

Additional Customer Location?

Yes

Ship-To Number: *

Account Address: *

Account City: *

Account State: *

Account Zip Code: *

Account Country: *

Account Contact Name (Authorized Signer): *

Account Contact Title (Authorized Signer): *

Account Contact Email Address (Authorized Signer): *

If they haven't already, please ensure the customer accepts the digital T&Cs as soon as possible.

Is a new 3DTRASAR controller being ordered? *

Yes

No

Please ensure you also complete the required EZ Setup form.

Agreement/Proposal Information

Type of document customer prefers to sign (only one signed document is required by the customer): *

Digital Program Agreement/Addendum

Digital Proposal

TVD Terms Agreed Upon (from commercial conversation): *

No TVD

TVD - No Commitment

TVD - Commitment at Site-Level

TVD Terms Agreed Upon (from commercial conversation): *

No TVD

TVD - No Commitment

TVD - Commitment

TVD Terms Agreed Upon (from commercial conversation): *

TVD - No Commitment

TVD - Commitment at Corporate Account/Enterprise-Level

TVD - Commitment at Site-Level

TVD Terms Agreed Upon (from commercial conversation): *

TVD - No Commitment

TVD - Commitment

TVD Selected? *

Yes

Effective Date of the Program: * +

Monthly Subscription Fees for the Initial Term ($/month per customer location): *

Percentage of the 2024 Annualized Fees for the Program at the Customer Location (site location 1 above): *

Percentage of the 2024 Annualized Fees for the Program at the Customer Location (site location 2 above): *

Percentage of the 2024 Annualized Fees for the Program at the Customer Location (site location 3 above): *

Percentage of TVD Target for the Initial Term: ____% of the 2024 cumulative annualized Fees for the Program at all Customer Locations *

Agreement Language: *

Billing Information

Billing Arrangement Type: *

Setup New BA

Amend Existing BA

Start Date (must be first day of any month): * +

End Date (must be last day of any month): * +

Billing Frequency: *

Monthly

Quarterly

Annually

Month to Begin Invoicing: *

Amount of Each Invoice: *

Billing Arrangement Total:

0.00

Billing Arrangement Total:

0.00

Billing Arrangement Total:

0.00

New or Updated Purchase Order Obtained: *

Yes

No

Purchase Order Number: *

Purchase Order:

Please ensure the new or updated PO is submitted via standard process for your group once obtained.

Existing Billing Arrangement Number: *

Month to Increase Invoicing: *

New or Updated Purchase Order Obtained: *

Yes

No

Purchase Order Number: *

Purchase Order:

Use Existing BA Purchase Order for This Invoicing?: *

Yes

No

Please ensure the new or updated PO is submitted via standard process for your group once obtained.

Comments:

Next Step: Please be sure to complete the Remote Intelligence form after submitting this form.