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Attachment II • <br /> BENTLEY SELECT PROGRAM AGREEMENT <br /> AMERICAS <br /> • SUBSCRIBER'S SITE INFORMATION <br /> Bentley SELECT Contract Number: 'kA 6, <br /> Use this form to list all sites and all Bentley products at each site to be covered by the Bentley SELECT Agreement. <br /> Please complete a copy of this form for each site covered and insert into the Bentley SELECT Agreement. A "site" is defined as a <br /> geographic location or a department within your organization that operates and manages the group's CAD installation <br /> as a discrete functional unit. <br /> SITE INFORMATION: <br /> Shipping Address: Billing Address (fd f rent): <br /> A�y c6aflek. Aha <br /> Company Company <br /> Site/Division SiteiDivision <br /> zed kekula- <br /> Management C start 7 Billi g Cont. t <br /> oto ( ;! ✓cc C'VY f 3�a 0._ ' A. / <br /> Address/Street(no P.O.Box) Address/Street(no P.O.Box) <br /> ft 50 m 1 ht! ./ _._ <br /> J9 ✓1 of <br /> -tort lu A-4,. 020 Ct'vic_ dor r `PL.aczc-_ <br /> City • City <br /> an- 9'2762- <br /> • State Zip Country State Zip Country <br /> 1/kocf7-57S8" 7N-6V?-267 <br /> Phone L Fax Phone Fax <br /> •6 !e— <br /> D gnated VAR <br /> PRODUCT/PLATFORM INFORMATION: • <br /> Please indicate quantity and platform of each product at the site above to be covered by Bentley SELECT Agreement. <br /> PRODUCT QUANTITY PLATFORM <br /> 'h Icr'o<5-1a-heir cPC__ <br /> Primary Industry Code Application CAD Usage <br /> (Refer to the back of this page for industry and CAD usage codes.) <br /> DAA009610-1/0001 <br />