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Investment Proposal <br />Approval to Proceed /invoice <br />Page 4 of 4 <br />Please provide the following information and sign where indicated. By signing below, Client authorizes System Innovators <br />to proceed with the efforts necessary to perform this statement of work and accepts the investment obligations and <br />responsibilities as defined. <br />Client System Innovators, <br />Agreed to: by its duly authorized representative: by its duly authorized representative: <br />Name: <br />Title: <br />Signature: <br />Date: <br />Anthony Rapaglia <br />Director, Sales <br />Billing Information <br />Please complete the billing and delivery information in the form below. If you require your purchase order number to be <br />included on invoices issued by System Innovators, please include the purchase order number in the form. <br />Bill To <br />Deliver To <br />Name: <br />Name: <br />Title: <br />Title: <br />Address: <br />Address: <br />City, State Zip: <br />City, State Zip: <br />Telephone: <br />Telephone: <br />E -mail: <br />E -mail: <br />PO #: <br />Note: This offer will expire on December 31, 2012 unless extended in writing by System Innovators. <br />Upon completing this investment schedule, please fax or e-mail all pages of the investment schedule to <br />System Innovators at (904) 281 -0075 or jsumner @systeminnovators.com. <br />System Innovators cannot schedule nor proceed with any work on this additional service until the client <br />has 1) provided all of the information requested in this investment schedule, 2) signed the investment <br />schedule, and 3) returned the investment schedule in its entirety to System Innovators. <br />(for internal use) <br />Project Number: ACCT #/TEAM: Professional Services Consultant: Kevin L. Schroeder <br />System Innovators — a division of N. Harris Computers <br />800.963.5000 • Fax: 904.281.0075 <br />25F -8 <br />10550 Deerwood Park Blvd., Suite 700 <br />Jacksonville, FL 32256 <br />