Business Request Application

BUSINESS REQUEST APPLICATION AND AGREEMENT

Parties and Recitals

Applicant Name:    Company/Provider Name:

Request Reference No.:    Request Date:

WHEREAS, Applicant seeks the services or deliverables described in this Business Request Application and Agreement (the "Request") for legitimate business purposes; and

WHEREAS, Company/Provider has the qualifications, personnel, and capacity to evaluate and, if accepted, deliver the requested services subject to the terms and conditions set forth herein; and

WHEREAS, the parties agree that submission of this Request constitutes a formal application to engage Company/Provider and, upon mutual execution of this Agreement, creates binding obligations as specified below.

Applicant Business Information

Corporation    Limited Liability Company (LLC)    Partnership    Sole Proprietorship

Requested Services

Consulting    Development    Business Analysis    Other (describe below)

Scope of Work

Describe the requested services, deliverables, milestones, acceptance criteria, and any specific performance standards. This description will form the operative Scope of Work upon acceptance by Company/Provider.

Payment Terms

Total Fee:    Payment Schedule: specify amounts, due dates, and conditions below.

Late Payment: Any undisputed past due amount shall accrue interest at a rate of or the maximum permitted by law, plus reasonable collection costs.

Term and Termination

Effective Date:    Termination Date (if applicable):

Either party may terminate this Agreement for convenience upon written notice to the other party delivered at least days prior to termination. Termination for cause may be immediate if the non‑breaching party provides written notice describing the breach and the breaching party fails to cure within 15 days.

Confidentiality

Each party acknowledges that during performance it may receive Confidential Information of the other party. "Confidential Information" includes business plans, pricing, financial data, trade secrets, client lists, technical data, and other non-public information disclosed in written, electronic, or oral form. Each party shall: (a) use Confidential Information solely for performance under this Agreement; (b) limit disclosure to employees, agents, and subcontractors with a need to know and who are bound by confidentiality obligations no less protective than those herein; and (c) use at least the same degree of care to protect Confidential Information as it uses for its own confidential materials, but in no event less than reasonable care.

Confidentiality obligations do not apply to information that is (i) publicly known at the time of disclosure or becomes publicly known through no fault of the receiving party; (ii) rightfully received from a third party without restriction; (iii) independently developed by the receiving party without access to the disclosing party's Confidential Information; or (iv) required to be disclosed by law or valid legal process, provided the disclosing party is given prompt notice to seek protective measures.

Governing Law and Dispute Resolution

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of laws principles. The parties agree that claims arising out of or in connection with this Agreement shall be resolved first through good faith negotiation and, if unresolved, through binding arbitration conducted in the county of the governing state, unless otherwise mutually agreed in writing.

Representations, Warranties and Covenants

Each party represents and warrants that it has full corporate or organizational power and authority to enter into this Agreement and to perform its obligations. Applicant represents that the information provided in this Request is true, accurate and complete to the best of Applicant's knowledge, and that Applicant is authorized to submit this Request on behalf of the business identified herein.

Entire Agreement

This Business Request Application and Agreement, together with any schedules, attachments, and accepted Scope of Work, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, and communications, whether written or oral. No amendment or modification shall be binding unless in writing and signed by authorized representatives of both parties.

Certifications and Authorizations

By submitting this Request and signing below, Applicant certifies that: (a) the information provided is true and correct; (b) Applicant has the authority to request the services and to enter into this Agreement; and (c) Applicant agrees to the terms and conditions contained herein. Applicant further authorizes Company/Provider to perform reasonable verification of the information supplied.

Authorization: I certify and authorize submission of this Request.

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