Page 168 - E-Rate 2020-21 Workbook
P. 168
CONTRACT RENEWAL ADDENDUM
SERVICE PROVIDER
Company Name
Address
City, ST Zip
Contact Person
Phone Number
Email address
APPLICANT
Organization Name
Address
City, ST Zip
Contact Person
Phone Number
Email address
SERVICE
Location Description
CONTRACT
In-Service Date
Original Contract date
Contract Terms
Contract Expiration Date if all
options are exercised
Non-Recurring Charges
Monthly Recurring Charges
Per the terms of the original contract, the parties agree to exercise the renewal for the fiscal year July 1,
2020 – June 30, 2021.
Service Provider Applicant
Signature Signature
Printed Name Printed Name
Title Date Title Date
