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Motionindustries. com You must register and login with a username and password to obtain your contract pricing. Commonwealth of Massachusetts FAC76 Statewide Contract Category 3 Industrial and Commercial Products and Supplies Contract Participation Form Submission of this form is an acknowledgement of the intent to purchase from the Commonwealth of Massachusetts FAC76 Statewide Contract with Motion Industries. Agency Type Select One Authority Includes MWRA MassPort Housing Authorities Legislative Branch etc. Executive Agency State Agencies Higher Education MassDOT Formally MTA and MassHighway Would you like a copy of Motion Industries Yes product catalog delivered to you Yes No Please list other contract vehicles you are using to purchase from Municipality Includes Schools Fire Police DPWs WWTP WSCA other City/Town Depts. NJPA Non-Profit/POS Purchase of Service U.S. Communities Other not included in the above list None Other Agency/Dept. All orders placed under the assigned account s are in accordance with the terms and conditions of this contract. Agency Type Select One Authority Includes MWRA MassPort Housing Authorities Legislative Branch etc. Executive Agency State Agencies Higher Education MassDOT Formally MTA and MassHighway Would you like a copy of Motion Industries Yes product catalog delivered to you Yes No Please list other contract vehicles you are using to purchase from Municipality Includes Schools Fire Police DPWs WWTP WSCA other City/Town Depts. NJPA Non-Profit/POS Purchase of Service U.S. Communities Other not included in the above list None Other Agency/Dept. Name Federal Tax ID FEIN or TIN First Last Name Billing Address City State Zip Phone Fax Email Address receive our e-newsletter authorized to purchase through this agreement Are you currently a Motion Industries Customer Yes please provide your account number s if available To make on-line purchases from Motion Industries visit www. All orders placed under the assigned account s are in accordance with the terms and conditions of this contract.

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