Delivery Request Form

DELIVERY REQUEST FORM

Requestor Name:    Carrier Name:

RECITALS

WHEREAS, Requestor is the owner or lawful custodian of goods described herein and requires transportation and delivery services for those goods; and

WHEREAS, Carrier is duly licensed and insured to provide cargo transportation and delivery services and is willing to provide such services to Requestor in accordance with the terms of this Delivery Request Form; and

WHEREAS, the parties agree that the terms set forth in this form shall govern the requested delivery(s) and related obligations between the parties from the Effective Date specified below.

Effective Date:

SCOPE OF WORK

DELIVERY DETAILS

ITEMS TO BE DELIVERED

Provide itemized description for each shipment. Additional sheets may be attached and incorporated by reference.

PAYMENT TERMS

Total Fee for Services: $

Late Payment: If payment is not received within days after invoice due date, interest shall accrue at % per month (or the maximum allowed by law), plus collection costs.

TERM AND TERMINATION

Term Start Date:    Term End Date (or event):

Either party may terminate this request for material breach if the breaching party fails to cure within days after written notice. Termination shall not relieve either party of obligations accrued prior to termination.

CONFIDENTIALITY

Each party acknowledges that it may receive Confidential Information of the other party. "Confidential Information" includes non-public business, financial, pricing, customer, and logistics information disclosed in connection with this request. The receiving party shall: (a) hold Confidential Information in strict confidence; (b) use it solely to perform obligations under this form; and (c) not disclose it except to employees, agents, or subcontractors with a need to know who are bound by confidentiality obligations no less protective than those herein.

Confidential obligations do not apply to information that: (i) is or becomes publicly known through no breach by the receiving party; (ii) is lawfully received from a third party without restriction; or (iii) is independently developed. If disclosure is required by law or court order, the receiving party shall give prompt written notice and cooperate reasonably with any protective measures.

Confidentiality obligations survive termination or expiration of this form for a period of three (3) years or longer if required by applicable law.

INSURANCE AND LIABILITY

Carrier warrants that it maintains insurance appropriate to the services, including commercial automobile and cargo insurance. Carrier shall provide proof of insurance upon request. Carrier's liability for loss or damage to goods shall be limited to declared value where declared or, absent declaration, to actual direct loss not to exceed the lesser of repair or replacement cost or $ unless otherwise agreed in writing.

GOVERNING LAW

This Delivery Request Form 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 out of this Form shall be in the courts located in the county specified here: .

ENTIRE AGREEMENT

This Delivery Request Form, together with any attachments or incorporated schedules, 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. Any amendment must be in writing and signed by authorized representatives of both parties.

ADDITIONAL TERMS

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