Equipment Add-On Request Form

EQUIPMENT ADD-ON REQUEST FORM

WHEREAS

WHEREAS, Requesting Party Name: ; Company/Division: (collectively, "Requesting Party").

WHEREAS, Provider Name: ; Provider Contact: (collectively, "Provider").

WHEREAS, Requesting Party and Provider are parties to an existing agreement under which Requesting Party wishes to procure certain additional equipment and related services (the "Add-On Equipment") and Provider is willing to supply and install such Add-On Equipment pursuant to the terms and conditions set forth below.

PARTIES & CONTACT INFORMATION

EQUIPMENT ADD-ON DETAILS

Provide a complete, itemized description of each piece of equipment requested below. Include model numbers, serial numbers (if available), and any required accessories or ancillary services.

SCOPE OF WORK

PAYMENT TERMS

Provider shall submit invoices to Requesting Party in accordance with the amounts set forth below. Requesting Party shall pay undisputed invoiced amounts within the period specified.

TERM AND TERMINATION

The term of this Add-On Request will commence on Start Date: and shall expire on End Date: , unless earlier terminated in accordance with this section.

Either party may terminate this Add-On Request for material breach by the other party, provided that the terminating party gives written notice specifying the breach and the breaching party fails to cure within Notice Period (days): days of receipt of such notice.

Upon termination, Requesting Party will pay Provider for all work performed and equipment delivered and accepted through the effective date of termination in accordance with the Payment Terms.

CONFIDENTIALITY

Each party acknowledges that, in the course of performance, it may receive confidential or proprietary information of the other party. Each party shall maintain such information in confidence and shall not use or disclose it except as necessary to perform obligations under this Add-On Request or as compelled by law, provided that the receiving party provides prior written notice to the disclosing party where permitted.

Confidential information does not include information that: (a) is or becomes generally available to the public other than by breach of this obligation; (b) is already in the receiving party's possession without restriction at the time of disclosure; or (c) is received from a third party without breach of any obligation of confidentiality.

I acknowledge and agree to be bound by the confidentiality terms above.

GOVERNING LAW

This Add-On Request shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of law principles. The parties submit to the exclusive jurisdiction of the state and federal courts located in that State for disputes arising under this Add-On Request.

ENTIRE AGREEMENT & REPRESENTATIONS

This Add-On Request, together with any attachments or referenced purchase orders signed by the parties, 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, modification or waiver shall be effective unless in writing and signed by authorized representatives of both parties.

Each party represents and warrants that it has full corporate power and authority to enter into this Add-On Request and to perform its obligations hereunder, and that the execution and delivery of this Add-On Request have been duly authorized.

APPROVALS AND NOTICES

ADDITIONAL TERMS

Installation services, if required, shall be performed by Provider in a workmanlike manner in accordance with industry standards. Any warranty for materials or workmanship will be as set forth in the existing agreement between the parties or, if none specified, a ninety (90) day warranty from completion of installation, except as otherwise agreed in writing.

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