Dealer Application Form

DEALER APPLICATION FORM AND DEALER AGREEMENT

RECITALS

WHEREAS, Company Name: (the "Company") manufactures, distributes, or licenses certain products and grants limited dealer rights for resale; and

WHEREAS, Dealer Business Name: (the "Applicant" or "Dealer") seeks appointment by the Company and submits this application and agreement subject to the terms set forth below.

NOW, THEREFORE, Applicant submits the following information for the Company's review. Submission does not constitute an appointment until accepted in writing by the Company.

BUSINESS INFORMATION

Corporation    Limited Liability Company    Partnership    Sole Proprietor    Other:

OWNERS / PRINCIPALS

BUSINESS OPERATIONS & SALES CHANNELS

Primary Sales Channels: Retail   Online/E-commerce   Wholesale   Fleet/Commercial   Other:

CREDIT, TRADE AND BANK REFERENCES

INSURANCE

Do you carry commercial general liability insurance that covers the products and operations applied for? Yes    No

SCOPE OF WORK

Describe the Dealer's responsibilities, permitted sales channels, marketing and support commitments, inventory stocking policies, training obligations, warranty handling, and any service commitments as contemplated by the parties:

PAYMENT TERMS

Initial Deposit or Minimum First Order Amount: $

Late payment charge: (or minimum $ )

TERM AND TERMINATION

Term Commencement Date: . Term Expiration Date (if any): .

Either party may terminate this appointment for convenience upon written notice of days to the other party. The Company may terminate immediately for cause, including material breach, insolvency, or misuse of intellectual property.

CONFIDENTIALITY

Applicant acknowledges that in the course of the relationship it may receive confidential and proprietary information of the Company. Applicant agrees to hold such information in strict confidence and not to disclose or use it except as necessary to perform obligations under this agreement and as authorized in writing by the Company. This obligation survives termination for a period of three (3) years.

GOVERNING LAW; ENTIRE AGREEMENT

This application and any resulting dealer appointment shall be governed by the laws of the State of , without regard to conflict of law principles. Exclusive venue for disputes shall be the state or federal courts located in that state.

This document constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior proposals, understandings, and communications, whether oral or written, concerning the same.

CERTIFICATION AND AUTHORIZATION

The undersigned certifies that the information provided in this application is true, complete, and correct. Applicant authorizes the Company and its agents to verify references, obtain credit reports, and conduct background checks as necessary to evaluate this application. Applicant agrees to indemnify and hold the Company harmless for reliance on the information provided.

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