Centurian Group

Ordering Instructions

CONTRACTOR:Centurian Group

SPURS VENDOR NUMBER:

eQuote/Agreement Administration

Please identify the person who will be responsible for administering the agreement on your behalf if award is made, and include an emergency contact phone number:

Name: Donald Maidlow

Title: President

Street Address:4013 Huxford Court

Email Address: dm.centuriangroup@verizon.net

Phone Number(s):813) 968-6233

Fax NumberL813) 968-6795

If the person responsible for answering questions about the agreement is different from the person identified above, please provide the same information for that person.

Name:

Title:

Street Address:

Email Address:

Phone Number(s):

Fax Number:

Direct Orders

Please provide the following information about where the Customers should direct orders.You must provide a regular mailing address.If equipped to receive purchase orders electronically, you may also provide an Internet address.

Street Address or P.O. Box:4013 Huxford Court

City, State, Zip:Tampa FL. 33624-1336

Phone NumberL813) 968-6233

Toll Free NumberL888) 968-6233

Ordering Fax NumberL813) 968-6795

Internet Address:

Federal ID Number:59-3430690

Remit Address:4013 Huxford Court

City, State, Zip:Tampa FL. 33624-1336

Email Address: dm.centuriangroup@verizon.net

Attach additional addresses for all locations in Florida authorized to perform services under this agreement.All locations must be registered in MyFloridaMarketPlace.