Delivery & Acceptance Receipt Form

Delivery & Acceptance Receipt Form

Deliverer Name:    Recipient Name:

Recitals

WHEREAS, Deliverer represents that it has prepared and tendered for delivery the goods, materials, or services described below in accordance with the applicable purchase order, contract, or invoice;

WHEREAS, Recipient acknowledges receipt of the goods, materials, or services at the location and time noted below and has inspected them as provided in this receipt;

WHEREAS, the parties intend that this Delivery & Acceptance Receipt constitute definitive evidence of delivery, inspection, and, where applicable, acceptance or conditional acceptance subject to the terms below.

Delivery Details

Purchase Order / Contract No.:    Carrier / Shipper:

Delivery Date:    Delivery Location:

Itemized Delivery

Inspection & Acceptance

Inspection Performed: Yes    Conforms to Specified Requirements: Yes    Exceptions Noted: Yes

Inspection Performed By (Printed):    Title/Position:

Scope of Work

Payment Terms

Total Amount Due: $

Late Payment Fee:

Term and Termination

Effective / Start Date:    End Date (if applicable):

Termination Notice Period: days

Confidentiality

The parties acknowledge that certain information disclosed in connection with the delivery and acceptance may be confidential. Each party shall hold confidential information in strict confidence and shall not disclose it to third parties except as required by law or with the prior written consent of the disclosing party. Confidential information does not include information that is or becomes publicly available without breach of this receipt, is already known to the receiving party without obligation of confidentiality, or is rightfully received from a third party without restriction.

Confidentiality Acknowledgment: I acknowledge the confidentiality terms above.

Governing Law

This Delivery & Acceptance Receipt shall be governed by and construed in accordance with the laws of the state or jurisdiction specified: . Venue for any action arising hereunder shall lie in the appropriate courts of that jurisdiction.

Entire Agreement

This Receipt, together with any documents incorporated by reference (including the referenced purchase order or contract), constitutes the entire agreement between the parties concerning the delivery and acceptance described herein. Any prior or contemporaneous agreements, understandings, or representations, whether written or oral, are superseded by this document, except to the extent expressly stated otherwise in a signed written amendment.

Acceptance Certification

By signing below, the undersigned Recipient certifies that the items listed above were received on the date indicated, were inspected to the extent noted, and that acceptance is granted subject to any exceptions expressly recorded. The Deliverer affirms that the goods, materials, or services were shipped as described and that any representations made in connection with the sale or delivery are true to the best of Deliverer's knowledge.

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