Business Application Data

BUSINESS APPLICATION DATA

This Business Application Data and Agreement (Agreement) is made effective as of by and between Applicant Name: and Provider Name: .

WHEREAS

WHEREAS, Applicant seeks to obtain goods and/or services and to provide application data to assess creditworthiness, capability, and suitability for a commercial engagement; and

WHEREAS, Provider is willing to consider the Applicant's request subject to the terms and conditions set forth in this Agreement and the information provided in this Business Application Data form; and

WHEREAS, the parties desire to set forth certain representations, responsibilities and payment terms applicable to any subsequent offer, acceptance, or statement of work executed pursuant to this Application.

BUSINESS IDENTIFICATION

Corporation    LLC    Partnership    Sole Proprietorship    Other (specify below)

PRIMARY CONTACT

BUSINESS PROFILE

REFERENCES & ATTACHMENTS

Attachments (check all that apply):
Financial statements (audited or compiled)    Recent tax returns    Certificate of good standing    Business plan / projections

GENERAL BUSINESS AGREEMENT

Applicant and Provider agree that submission of this Business Application Data constitutes an offer by Applicant to enter into a commercial arrangement subject to these terms and any mutually executed statement of work. The parties expressly agree that execution of a separate statement of work or purchase order that references this Agreement shall incorporate the terms hereof unless otherwise agreed in writing.

SCOPE OF WORK

The specific goods and services to be provided, delivery schedules, acceptance criteria, and project milestones will be set out in a mutually executed statement of work. Provide a concise description of the initial scope sought through this Application:

PAYMENT TERMS

Unless otherwise agreed in a written statement of work, Applicant agrees to the following payment terms:

All sums due under this Agreement are payable in lawful currency and are exclusive of applicable taxes unless otherwise stated. Applicant will be responsible for reasonable collection costs, including attorneys' fees, incurred by Provider to collect overdue amounts.

TERM AND TERMINATION

The term of this Agreement and any services provided under an executed statement of work shall commence on and shall continue until unless earlier terminated as provided below.

Either party may terminate for convenience upon providing written notice no fewer than prior to the intended termination date. Termination for cause may occur where a party materially breaches this Agreement and fails to cure within thirty (30) days after receipt of written notice describing the breach.

CONFIDENTIALITY

Each party acknowledges that during the term of this Agreement it may receive Confidential Information of the other party. Confidential Information includes non-public business, financial, technical, and commercial information disclosed in any form. Receiving party shall: (a) use Confidential Information solely to evaluate or perform under this Agreement; (b) restrict disclosure to its employees, agents, and contractors who have a need to know and are bound by confidentiality obligations; and (c) exercise at least the same degree of care to protect Confidential Information as it uses to protect its own confidential information, but in no event less than reasonable care. Confidential Information does not include information which is or becomes publicly known through no wrongful act of the receiving party or is rightfully received from a third party without breach of an obligation.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflicts of law principles. Venue for any dispute arising from this Agreement shall lie exclusively in the state or federal courts located in that state.

ENTIRE AGREEMENT

This Agreement, together with any executed statements of work and attachments referenced herein, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior agreements, proposals, representations, and understandings, whether written or oral. No modification, amendment, or waiver shall be effective unless in writing signed by authorized representatives of both parties.

CERTIFICATIONS & AUTHORIZATIONS

By signing below, Applicant certifies that the information provided in this Business Application Data form is true, accurate, and complete to the best of Applicant's knowledge. Applicant authorizes Provider and its agents to verify any information provided, including obtaining credit reports and references, and to disclose information to third parties as required to assess eligibility and perform due diligence.

Applicant further acknowledges that any material misrepresentation may constitute cause for immediate rejection of this Application or termination of any agreement entered into as a result.

Authorization to Proceed: Applicant authorizes Provider to proceed with credit assessment and engagement negotiations under the terms set forth herein.

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