51
Technology for Telehealth Services - NKHS March 13, 2020 COVID-19 Pandemic ITEM DESCRIPTION / CALCULATIONS AMOUNT SOURCE AMOUNT SOURCE Inv. #57580586 3/13/20 2 Chat 70 U Speakersphone @ 98.32 196.64 196.64 FCC Inv. #57588083 3/17/20 1 RSA 25 pack SID700 Tokens 1,408.16 1,408.16 FCC Inv. #57588613 3/17/20 5 TLP-E ABPro 2017 Perp 160P @ 181.28 906.40 906.40 FCC Inv. #5605894 3/18/2020 10 Webcam C920 (Backordered) 753.70 - 753.70 FCC Inv. #57605894 3/24/2020 10 ClearOne CHAT 70-U Speakersphones@ 98.32 983.20 - 983.20 FCC Inv. #57612993 3/26/20 1 RSA 25 pack SID700 Tokens (36 months) 1,408.16 - 1,408.16 FCC Inv. #13130336 3/26/2020 50 Zoom hosts annual cost - Zoom Video Communications @ 199.90 9,995.00 8,258.20 Zoom proration credits 1,736.80 FCC Inv. #57618571 3/29/20 1 RSA 25 pack SID700 Tokens 1,408.16 - 1,408.16 FCC Inv. #57618607 3/29/20 50 Cust. Acad CWS Bndl 1 Perp lic. @ 435.00 + 50 Acad CWS Bundle Mnt @105.00 27,000.00 - 27,000.00 FCC Inv. #57628356 4/1/20 4 Chat 70-U Speakerphones @ 98.32 393.28 - 393.28 FCC Inv. #57634358 4/3/20 3 Lenovo TopSeller Think Pad E595, W10P, RYZEN5 1 YR @ 659.00 1,977.00 - 1,977.00 FCC Inv. #57636474 4/6/20 50 RSA Lic Base 30-100 @ 73.94 + 300 RSA 1M Sup Base 30-100 @ 1.47 4,138.00 - 4,138.00 FCC Inv. #57637321 4/6/2020 12 Acer CB151 Chromebook @ 502.40 6,028.80 - 6,028.80 FCC Inv. #57639903 4/7/2020 4 Xerox B215 DNI Multifunction Printer/Fax @ 211.99 847.96 - 847.96 FCC TOTAL VALUE CONTRIBUTED RESOURCES GRANTS RESOURCES

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Page 1: Technology for Telehealth Services - NKHS March 13, 2020

Technology for Telehealth Services - NKHS March 13, 2020 COVID-19 Pandemic

ITEM DESCRIPTION / CALCULATIONS AMOUNT SOURCE AMOUNT SOURCE

Inv. #57580586

3/13/20 2 Chat 70 U Speakersphone @ 98.32 196.64 196.64 FCC

Inv. #57588083

3/17/20 1 RSA 25 pack SID700 Tokens 1,408.16 1,408.16 FCC

Inv. #57588613

3/17/20 5 TLP-E ABPro 2017 Perp 160P @ 181.28 906.40 906.40 FCC

Inv. #5605894

3/18/2020 10 Webcam C920 (Backordered) 753.70 - 753.70 FCC

Inv. #57605894

3/24/2020

10 ClearOne CHAT 70-U Speakersphones@

98.32 983.20 - 983.20 FCC

Inv. #57612993

3/26/20 1 RSA 25 pack SID700 Tokens (36 months) 1,408.16 - 1,408.16 FCC

Inv. #13130336

3/26/2020

50 Zoom hosts annual cost - Zoom Video

Communications @ 199.90 9,995.00 8,258.20

Zoom

proration

credits 1,736.80 FCC

Inv. #57618571

3/29/20 1 RSA 25 pack SID700 Tokens 1,408.16 - 1,408.16 FCC

Inv. #57618607

3/29/20

50 Cust. Acad CWS Bndl 1 Perp lic. @ 435.00

+ 50 Acad CWS Bundle Mnt @105.00 27,000.00 - 27,000.00 FCC

Inv. #57628356

4/1/20 4 Chat 70-U Speakerphones @ 98.32 393.28 - 393.28 FCC

Inv. #57634358

4/3/20

3 Lenovo TopSeller Think Pad E595, W10P,

RYZEN5 1 YR @ 659.00 1,977.00 - 1,977.00 FCC

Inv. #57636474

4/6/20

50 RSA Lic Base 30-100 @ 73.94 + 300 RSA

1M Sup Base 30-100 @ 1.47 4,138.00 - 4,138.00 FCC

Inv. #57637321

4/6/2020 12 Acer CB151 Chromebook @ 502.40 6,028.80 - 6,028.80 FCC

Inv. #57639903

4/7/2020

4 Xerox B215 DNI Multifunction Printer/Fax

@ 211.99 847.96 - 847.96 FCC

TOTAL VALUE

CONTRIBUTED RESOURCES GRANTS RESOURCES

Page 2: Technology for Telehealth Services - NKHS March 13, 2020

Inv. #57642539

4/8/2020 1 Fujitsu ScanSnap iX1500 @ 461.55 461.55 - 461.55 FCC

Inv. #57671787

4/23/20 (on quote

#11567405.03

4/23/20)

2 HPE DL360 Gen 10 @ 2929.00 + 2 HPE

32GB @ 380.00 + 2 800W FS PLAT HPLUG

Kit@ 359.00 + 6 240GB SATA RI SFF @ 299.00 9,130.00 - 9,130.00 FCC

Inv. #57675061

4/24/20 (on quote

#11567405.03

4/23/20)

50 RSA Lic Base 30-100 @ 73.94 + 250 RSA

1M Sup Base 30-100 @ 1.47 4,064.50 - 4,064.50 FCC

Inv. #17294213

4/24/20

60 Zoom hosts annual cost - Zoom Video

Communications @ 199.90 11,994.00 10,415.60

Zoom

proration

credits 1,578.40 FCC

Inv. #57676962

4/26/20 (on quote

#11567405.03

4/23/20) 2 RSA 25 pack SID700 Tokens @ 1408.16 2,816.32 - 2,816.32 FCC

Inv. #57682720

4/28/20 16 Thinkbook 8GB, 256GB @ 798.00 12,768.00 - 12,768.00 FCC

Inv. #18458251

4/30/2020

10,000 eSignature Business Pro Edition -

Envelope Subs/Envelope Allowance

(4/30/2020 - 4/29/2021) 13,000.00 - 13,000.00 FCC

Inv. #18458251

4/30/2020

eSignature Premier Support (4/30/2020 -

4/29/2021 1,950.00 - 1,950.00 FCC

Inv. #57693425

5/1/20

50 Cust Acad CWS Bndl 1 Perp Lic @ 444.87 +

50 Cust Acad Cws Bndl Mnt 1Y @ 105.00 27,493.50 - 27,493.50 FCC

Pending

100 smart phones for Directors and

Supervisors @ 400.00 ea. 40,000.00 - 40,000.00 FCC

Pending

100 monthly cell phone plans for 12 months

based on current plans @45/month 54,000.00 - 54,000.00 FCC

Page 3: Technology for Telehealth Services - NKHS March 13, 2020

Quote #11567405.03

4/23/20 30 ThinkPad E15 Core i5-1-210U @ 798.00 23,940.00 - 23,940.00 FCC

Quote #11567405.03

4/23/20

2 HP servers and associated hardware for

Citrix connection @ 4565.00 ea. 9,130.00 - 9,130.00 FCC

Amazon

10 USB Speakerphone - eMeet M0

Conference speaker @ 69.99(?) ea. 699.90 699.90 FCC

Amazon 100 Kindle Fire tablets @ 79.99 7,999.00 7,999.00 FCC

276,891.23 258,217.43

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INVOICE

Zoom Video Communications Inc.55 Almaden Blvd, 6th FloorSan Jose, CA [email protected]

For ACH and Wire Transfer payment:Account Name: Zoom Video Communications, Inc.Bank Name: Wells Fargo BankAccount Number: 3088920149Routing Number(WT): 121000248Routing Number(ACH): 121042882SWIFT Code: WFBIUS6S

OR send check payment to:Zoom Video Communications Inc.PO BOX 398843San Francisco, CA94139-8843

Purchase Order #:

TaxExemptCertificateID:

Zoom W-9

Invoice Date:Invoice #:

Payment Terms:Due Date:

Account NumberCurrency:

Account Information:

03/26/2020INV13130336Net 3004/25/202051507595USDNORTHEAST KINGDOM HUMAN SERVICESPO Box 724, Newport, Vermont 05855United [email protected]

CHARGE DETAILS

Charge Description Service Period Subtotal Tax TOTAL

Charge Name: Standard Biz Annual -- Proration Credit Quantity: 40Unit Price: $199.90

03/26/2020-02/06/2021 ($6,947.34) ($416.84) ($7,364.18)

Charge Name: Standard Biz Annual -- Proration Quantity: 50Unit Price: $199.90

03/26/2020-02/06/2021 $8,684.18 $521.05 $9,205.23

INVOICE TOTALS

Subtotal: $1,736.84

Total (Including Tax): $1,841.05

Invoice Balance: $1,841.05

TAX DETAILS

Charge Name Tax Name Jurisdiction Charge Amount

Tax Amount

Standard Biz Annual Sales Tax State ($6,947.34) ($416.84)

Page 15: Technology for Telehealth Services - NKHS March 13, 2020

INVOICE

Standard Biz Annual Sales Tax State $8,684.18 $521.05Total

Tax $104.21

Zoom Phone services provided by Zoom Voice Communications, Inc. Rates, terms and conditions for Zoom Phone services are set by Zoom

Voice Communications, Inc.

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Salesperson: Matthew Healy

Phone: (800) 998-0079 ext. 33296

Fax: (603) 683-0623

(603) 683-2000 Email: [email protected] Date: 4/23/2020

Valid Through: 5/3/2020

Customer Contact: Tim Gould Phone: (866) 639-6547 x1106

Email: [email protected] Fax:

DELIVERY FOB SHIP VIA SHIP WEIGHT TERMS FEDERAL ID#

DestinationSmall Package Ground Service

Level293.00 lbs NET 30 02-0497006

* Line # Qty Item # Mfg. Part # Description Mfg. Price Ext

10 2 10900635SID700-6-60-36-

25

Corp. RSA SecurID Authenticator SID700

(36 months) 25 Pack

Rsa Security Licensing

Rsa Security

Licensing1,408.16$ 2,816.32$

20 50 16812265 AUT0000100B8

Authentication Manager Base Edition (8.0)

Perpetual License (30-100 User Level)

Rsa Security Licensing

Rsa Security

Licensing73.94$ 3,697.00$

30 300 16812206 AUT0000100BE1-8

Authentication Manager Base Edition (8.0)

1-Month Tech Support & Phone

Consulting (30-100 Users)

Rsa Security Licensing

Rsa Security

Licensing1.47$ 441.00$

40 50 38255050

Cust. Citrix Workspace Bundle - x1

Perpetual License

Citrix Easy Licensing

Citrix Easy

Licensing444.87$ 22,243.50$

50 50 38255092

Cust. Citrix Support Software Maintenance-

for Workspace Bundle - 1 year

Citrix Easy Licensing

Citrix Easy

Licensing105.00$ 5,250.00$

60 2 37638454 P19777-B21

ProLiant DL360 Gen10 1U RM Xeon 16C

Gold 5218 2.3GHz / 32GB / 8x2.5" HP

bays / P408i-a / 4xGbE / 1x800W

HP Servers

HP Servers 2,929.00$ 5,858.00$

70 2 36853232 P00924-B21

HP Compatible 32GB PC4-23400 288-pin

DDR4 SDRAM RDIMM

HP Server Accessories

HP Server

Accessories380.00$ 760.00$

80 2 34318068 865414-B21

800W Flex Slot Platinum Hot Plug Low

Halogen Power Supply Kit

HP Server Accessories

HP Server

Accessories359.00$ 718.00$

90 6 37614962 P18420-B21

240GB SATA 6Gb / s Read Intensive SFF

2.5" SC Multi Vendor Solid State Drive

HP Server Accessories

HP Server

Accessories299.00$ 1,794.00$

100 30 37640757 20RW005PUS

ThinkBook 15 IML Core i5-10210U

1.6GHz / 8GB / 256GB PCIe / ac / BT / FR

/ WC / 15.6" FHD / W10P64

Lenovo Commercial Systems

Lenovo

Commercial

Systems

798.00$ 23,940.00$

Subtotal 67,517.82$

Fee 0.00$

Shipping and

Handling0.00$

Tax 0.00$

Total 67,517.82$

$1,931.68/Mo.

(802) 334-7451 (802) 334-7451

*Lease for as low as:

SALES QUOTEPC Connection Sales Corp. # 11567405.03730 Milford Road PLEASE REFER TO THE ABOVE

QUOTE # WHEN ORDERINGMerrimack, NH 03054-4631

NORTHEAST KINGDOM HUMAN SERVICES INC

181 CRAWFORD RD

BILL TO: SHIP TO:

AB#: 5297492 AB#: 13492899

NORTHEAST KINGDOM HUMAN SERVICES INC

PO BOX 724 TIM GOULD

NEWPORT, VT 05855

NEWPORT, VT 05855

Page 1 of 4 4/23/2020

Page 37: Technology for Telehealth Services - NKHS March 13, 2020

Salesperson: Matthew Healy

Phone: (800) 998-0079 ext. 33296

Fax: (603) 683-0623

(603) 683-2000 Email: [email protected] Date: 4/23/2020

Valid Through: 5/3/2020

Customer Contact: Tim Gould Phone: (866) 639-6547 x1106

Email: [email protected] Fax:

DELIVERY FOB SHIP VIA SHIP WEIGHT TERMS FEDERAL ID#

DestinationSmall Package Ground Service

Level293.00 lbs NET 30 02-0497006

* Line # Qty Item # Mfg. Part # Description Mfg. Price Ext

(802) 334-7451 (802) 334-7451

SALES QUOTEPC Connection Sales Corp. # 11567405.03730 Milford Road PLEASE REFER TO THE ABOVE

QUOTE # WHEN ORDERINGMerrimack, NH 03054-4631

NORTHEAST KINGDOM HUMAN SERVICES INC

181 CRAWFORD RD

BILL TO: SHIP TO:

AB#: 5297492 AB#: 13492899

NORTHEAST KINGDOM HUMAN SERVICES INC

PO BOX 724 TIM GOULD

NEWPORT, VT 05855

NEWPORT, VT 05855

Important Notice - Standard Terms of Sale: Pricing valid for quantities shown until expiration date, excluding memory and hard drives. All purchases from PC Connection, Inc. are subject to the

Company's Standard Terms of Sale, which describe important legal rights and obligations. You may review the Standard Terms of Sale on the Company's website - pcconnection.com, or you

may request a copy via fax, e-mail, or mail by calling 1-800-800-0011 or your account representative. It is the end user's responsibility to review, understand and agree to the terms of any End

User License Agreement ("EULA").

* The amount is indicative of a 36-month, Fair Market Value (FMV) lease provided by Connection Financial Services and/or other Connection finance partners. Assumes order is predominantly

made up of hardware. If the majority of this quote represents software and/or services, please contact your Connection Account Manager to seek a custom lease quote. Lease offerings are

subject to credit approval and other lease terms and conditions.

Page 2 of 4 4/23/2020

Page 38: Technology for Telehealth Services - NKHS March 13, 2020

Qty Item # Manuf. Part # Description Manuf. Price Ext

2 34376559 H8QF0E3-Year Foundation Care 24x7 for DL360 Gen10

Service

HP

ESSN/Services $ 1,997.79 $ 3,995.58

2 34533294 H8QD9E3-Year Next Business Day Foundation Care for

DL360 Gen10

HP

ESSN/Services $ 648.96 $ 1,297.92

2 34753140 H8QK7E5-Year Foundation Care Next Business Day DL360

Gen10 Service

HP

ESSN/Services $ 2,406.14 $ 4,812.28

2 35658187 H8QM1E 5-Year Proactive Care 24x7 DL360 Gen10 ServiceHP

ESSN/Services $ 6,119.19 $ 12,238.38

Qty Item # Manuf. Part # Description Manuf. Price Ext

30 15686623 5WS0A23681 3-Year On-site Next Business Day (Grp Limited)

Lenovo Think Plus

- ThinkPad

Protection/Service

s

$ 88.77 $ 2,663.10

30 15686631 5WS0A23813 3-Year Depot/CCI

Lenovo Think Plus

- ThinkPad

Protection/Service

s

$ 68.82 $ 2,064.60

30 36539526 5WS0T361513-Year Premier Support with On-site Next Business

Day

Lenovo Think Plus

- ThinkPad

Protection/Service

s

$ 138.65 $ 4,159.50

30 33621604 5PS0N731563-Year On-site + Accidental Damage Protection +

Premier Support + Keep Your Drive

Lenovo Think Plus

- ThinkPad

Protection/Service

s

$ 213.19 $ 6,395.70

30 8597981 SCBF-LTO36E-09512503 Year Next Business Day On-Site w/ ADP ($0-

$1250)ServiceConnection $ 227.50 $ 6,825.00

30 5824228 SCBF-LPT36E-095BRZ1250

SC 3Yr Plan (1Yr Base) Notebooks/Tablet ($0-

1,250) 9x5 Phone, Unlimited Acc Dam, Depot

Repair

ServiceConnection $ 253.25 $ 7,597.50

30 37914324 661073 3-Year Depot for NB (701-2,000) Service Net $ 171.20 $ 5,136.00

30 37914261 661067 1-Year Depot for NB (701-2,000) Service Net $ 46.81 $ 1,404.30

By purchasing a Service Connection Plan you agree to the terms and conditions set forth in this document and the particular service

plan purchased.

Warranty Options for Quote# 11567405.03

Ask your Account Manager about the following Warranty Options that are available for items that were quoted.

Options for: Item# 37638454 - ProLiant DL360 Gen10 1U RM Xeon 16C Gold 5218 2.3GHz / 32GB / 8x2.5" HP bays / P408i-a / 4xGbE / 1x800W (Choose

one)

Please ask your Account Manager about other warranties and service offerings that are available.

Options for: Item# 37640757 - ThinkBook 15 IML Core i5-10210U 1.6GHz / 8GB / 256GB PCIe / ac / BT / FR / WC / 15.6" FHD / W10P64 (Choose one)

Page 3 of 4 4/23/2020

Page 39: Technology for Telehealth Services - NKHS March 13, 2020

Item # Description Notes

10900635Corp. RSA SecurID Authenticator

SID700 (36 months) 25 Pack

Product Description: The RSA SecurID 700 hardware device is a smaller keyfob model that connects

easily to any key ring and is very convenient for the end user. Every 60 seconds it displays a new code

generated by the RSA SecurID AES algorithm.

16812265

Authentication Manager Base Edition

(8.0) Perpetual License (30-100 User

Level)

Product Description: The database replication feature of the RSA Authentication Manager enables

flexible network configuration and load balancing for improved performance and can ultimately result in

lower management costs. The Base Edition provides one master server and one replicated server.

User administration and authentication is handled by the master server and all information is duplicated

on the replica. Both servers are capable of handling authentication requests; the RSA Authentication

Agents balance the work load between the servers by detecting response times and directing the

request accordingly, to ensure optimum performance.

16812206

Authentication Manager Base Edition

(8.0) 1-Month Tech Support & Phone

Consulting (30-100 Users)

Product Description: Enhanced Support is designed to meet the support needs of customers with

business-critical systems. RSA is focused on minimizing disruption of your business critical systems,

that depend on RSA solutions and products by getting your systems up and running to the great extent

possible.

38255050Cust. Citrix Workspace Bundle - x1

Perpetual License

Product Description: Deliver secure access to apps, data and services from most devices with the Citrix

Workspace Suite. This complete and powerful solution is optimized to meet the performance, security

and mobility requirements of each individual, with instant access to personalized desktops, mobile,

web, apps, data and services over any network. Freedom to choose how, where and when work

happens enables workforce mobility and productivity.

37638454

ProLiant DL360 Gen10 1U RM Xeon 16C

Gold 5218 2.3GHz / 32GB / 8x2.5" HP

bays / P408i-a / 4xGbE / 1x800W

Product Description: Does your data center need a secure, performance driven dense server that you

can confidently deploy for virtualization, database, or high-performance computing? The HPE ProLiant

DL360 Gen10 server delivers security, agility and flexibility without compromise.

34318068800W Flex Slot Platinum Hot Plug Low

Halogen Power Supply Kit

Product Description: HPE Flexible Slot (Flex Slot) Power Supplies share a common electrical and

physical design that allows for hot plug, tool-less installation into HPE server solutions. HPE's Flex Slot

power supplies are certified for high-efficiency operation and offer multiple power output options,

allowing users to "right-size" a power supply for specific server configurations. This flexibility helps to

reduce power waste, lower overall energy costs, and avoid "trapped" power capacity in the data

center.

37614962

240GB SATA 6Gb / s Read Intensive

SFF 2.5" SC Multi Vendor Solid State

Drive

Product Description: Do you need more performance from your sever or platform? HPE SSDs deliver

advanced performance and endurance while reducing power consumption for customers with

applications requiring high random read and write IOPs performance.

Ports/Connectors: 7-pin SATA 6Gb/s port

Product Notes for Quote# 11567405.03

Page 4 of 4 4/23/2020

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INVOICE

Zoom Video Communications Inc.55 Almaden Blvd, 6th FloorSan Jose, CA [email protected]

For ACH and Wire Transfer payment:Account Name: Zoom Video Communications, Inc.Bank Name: Wells Fargo BankAccount Number: 3088920149Routing Number(WT): 121000248Routing Number(ACH): 121042882SWIFT Code: WFBIUS6S

OR send check payment to:Zoom Video Communications Inc.PO BOX 398843San Francisco, CA94139-8843

Purchase Order #:

TaxExemptCertificateID:

Zoom W-9

Invoice Date:Invoice #:

Payment Terms:Due Date:

Account NumberCurrency:

Account Information:

04/24/2020INV17294213Net 3005/24/202051507595USDNORTHEAST KINGDOM HUMAN SERVICESPO Box 724, Newport, Vermont 05855United [email protected]

CHARGE DETAILS

Charge Description Service Period Subtotal Tax TOTAL

Charge Name: Standard Biz Annual -- Proration Quantity: 60Unit Price: $199.90

04/24/2020-02/06/2021 $9,470.67 $568.24 $10,038.91

Charge Name: Standard Biz Annual -- Proration Credit Quantity: 50Unit Price: $199.90

04/24/2020-02/06/2021 ($7,892.23) ($473.53) ($8,365.76)

INVOICE TOTALS

Subtotal: $1,578.44

Total (Including Tax): $1,673.15

Invoice Balance: $1,673.15

TAX DETAILS

Charge Name Tax Name Jurisdiction Charge Amount

Tax Amount

Page 43: Technology for Telehealth Services - NKHS March 13, 2020

INVOICE

Standard Biz Annual Sales Tax State ($7,892.23) ($473.53)

Standard Biz Annual Sales Tax State $9,470.67 $568.24Total

Tax $94.71

Zoom Phone services provided by Zoom Voice Communications, Inc. Rates, terms and conditions for Zoom Phone services are set by Zoom

Voice Communications, Inc.

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INVOICEDocuSign Inc.

Remittance slips can be emailed to [email protected]*-Taxation based on ‘Ship To’ address information.For additional information, including answers to frequently asked billing questions, please visit our Billing Support site at: https://www.docusign.com/support

Invoice Date:Invoice #:

Payment Terms:Due Date:

Purchase Order #:Account Name:

Apr 30, 2020INV18458251Net 30May 30, 202041360Northeast Kingdom Human Services, Inc.

Billing Account #: A00965454

Bill To: Northeast Kingdom Human Services, [email protected] Crawford Road Derby, Vermont05829United States

Ship To: Northeast Kingdom Human Services, [email protected] Crawford Road DerbyVermont05829United States

Subscription Item Description ServicePeriod Quantity Tax

Amount Extended Price

O-0022571515882

80698478

SKU-0000067

1

eSignature Business Pro Edition - Envelope Subs. (Adopt.Accel.)-Envelope Allowance

04/30/2020-04/29/2021 10,000 0.00 13,000.00

O-0022571515882

80698478

SKU-0000063

5Adoption QuickStart-Adoption QuickStart 04/30/2020-

04/30/2020 1 0.00 0.00

O-0022571515882

80698478

SKU-0000018

0Premier Support-Premier Support 04/30/2020-

04/29/2021 1 0.00 1,950.00

Subtotal: 14,950.00

Tax*: 0.00

Total: 14,950.00

Currency: USD

TRANSACTIONS ASSOCIATED TO THIS INVOICETotal Adjustments 0.00

Total Credits - 0.00

Total Payments - 0.00

Invoice Balance 14,950.00

Currency USD

PLEASE NOTE THE CHANGE IN OUR PREFERRED PAYMENT METHOD BELOW

Please remit electronic payments to:Silicon Valley Bank3003 Tasman DriveSanta Clara, CA 95054Routing #: 121140399Account #: 3300414688Swift Code: SVBKUS6S

Please remit checks to:DocuSign Inc.DEPT 3428PO BOX 123428DALLAS, TX 75312-3428

For Courier Deposits (Fed EX, UPS, etc.):Dallas Regional LockboxDocuSign Inc.8934281501 North Plano Rd Ste. 100Richardson, TX 75081