Electrical Services Request Form

ELECTRICAL SERVICES REQUEST FORM

WHEREAS

WHEREAS, Client Name: (referred to herein as "Client");

AND WHEREAS, Service Provider: (referred to herein as "Provider"), licensed and qualified to perform electrical work; and

NOW, THEREFORE, the parties agree that Provider will perform electrical services as requested by Client in accordance with the terms set forth in this Request Form and the attached Scope of Work.

REQUEST SUMMARY

JOB DETAILS

Type of Service (check all that apply):

Emergency Repair Installation Inspection Maintenance

PAYMENT TERMS

Estimated Total Amount: $

Accepted Payment Methods: Credit Card Check ACH / Bank Transfer Cash

Late Payment: If any amount remains unpaid after the due date specified in the invoice, Client shall owe a late fee of and reasonable collection costs, including attorneys' fees.

TERM AND TERMINATION

Commencement Date:     Termination (or Estimated End) Date:

Either party may terminate this Request and any resulting service agreement for material breach if the breaching party fails to cure the breach within days after written notice. Termination by Client prior to substantial completion may require payment for work performed, materials purchased, and reasonable demobilization costs.

CONFIDENTIALITY

Both parties acknowledge that in the performance of services they may receive Confidential Information. "Confidential Information" means nonpublic business or technical information identified as confidential at disclosure or that reasonably should be understood to be confidential. Each party shall (a) use Confidential Information solely for performance under this Request, (b) limit disclosure to employees or subcontractors with a need to know, and (c) protect Confidential Information with reasonable care. Confidential Information does not include information that is publicly available through no breach by the receiving party, lawfully received from a third party, or independently developed.

RISK, INSURANCE, AND COMPLIANCE

Provider warrants that it is properly licensed to perform electrical services and will maintain insurance coverage customary for the trade. Provider shall comply with all applicable codes, ordinances, and permit requirements. Client is responsible for disclosing any known concealed hazards or conditions that could affect safety or cost.

GOVERNING LAW

This Request and any resulting agreement shall be governed by and construed in accordance with the laws of the state of without regard to conflicts of law principles.

ENTIRE AGREEMENT

This Request, together with any written Scope of Work and pricing attachments executed by the parties, constitutes the entire agreement between Client and Provider with respect to the subject matter and supersedes all prior proposals, understandings, and communications, whether written or oral. Any modification or waiver must be in writing and signed by an authorized representative of each party.

AUTHORIZATION

By signing below, Client authorizes Provider to schedule and perform the services described herein and acknowledges the Payment Terms. Client further authorizes Provider to obtain permits as necessary and to perform such work in accordance with applicable codes.

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