Equipment Lease and Purchase Request Form

Equipment Lease and Purchase Request Form

Requesting Party Name:   Company:

Requesting Party Contact:   Phone:   Email:

Supplier / Lessor Name:   Company:

Supplier Contact:   Phone:   Email:

Recitals

WHEREAS, Requesting Party has requested to lease or purchase certain equipment for commercial use and has submitted this Equipment Lease and Purchase Request Form to Supplier / Lessor; and

WHEREAS, Supplier / Lessor represents that it is willing to provide the requested equipment and related services on the terms and conditions set forth below, subject to credit approval, delivery lead times, and execution of the applicable Lease or Sale Agreement; and

WHEREAS, the parties intend that this Request Form, upon acceptance by Supplier / Lessor, will govern the initial commercial terms for the requested lease or purchase and serve as the basis for any subsequent formal agreement.

Request Details

Lease    Purchase

Equipment Schedule (Itemize)

Item 1

Quantity:   Unit Price:   Serial / Model:

Item 2

Quantity:   Unit Price:   Serial / Model:

Item 3

Quantity:   Unit Price:   Serial / Model:

Scope of Work

Describe scope of delivery, installation, startup, training, and acceptance criteria. Include performance standards and milestones.

Payment Terms

Total Contract Amount:   Down Payment / Deposit:

Monthly Lease Payment (if applicable):   Purchase Option Price (if applicable):

Late Payment Fee:   Collection Costs and Interest: unpaid amounts shall accrue interest and the prevailing collection costs will be chargeable to the delinquent party.

Term and Termination

Proposed Lease / Agreement Start Date:   Proposed End Date / Term:

Either party may terminate for material breach if the breaching party fails to cure within days after receiving written notice. Early termination charges, if any, will be determined in accordance with the executed Lease or Sale Agreement.

Insurance, Maintenance & Warranty

Supplier to maintain insurance as required    Requesting Party to maintain insurance as required

Maintenance responsibility:   Service Agreement Required:

Acceptance & Inspection

Inspection Period: Requesting Party shall inspect equipment within days of delivery. Acceptance shall be deemed complete upon written confirmation of installation and functional testing, or upon expiration of the inspection period without written rejection.

Confidentiality

Each party agrees to hold confidential all non-public information received from the other party in connection with this Request Form and any subsequent agreement, and shall not disclose such information except to its employees, agents, or contractors having a need to know and who are bound by confidentiality obligations. Confidential information does not include information that is or becomes publicly known through no breach of this clause, is rightfully received from a third party without restriction, or is independently developed. Breach of confidentiality shall entitle the non-breaching party to injunctive relief in addition to other remedies at law or equity.

Governing Law

This Request Form and any subsequent agreement formed in reliance hereon shall be governed by and construed in accordance with the laws of the State of without regard to conflict of law principles. Venue for any dispute shall be the state or federal courts located in that jurisdiction.

Entire Agreement and Acceptance

This Request Form, together with any written acceptance or quote issued by Supplier / Lessor and executed by both parties, constitutes the entire understanding between the parties with respect to the subject matter hereof and supersedes all prior proposals, negotiations, and communications. Any changes or additions shall be effective only if set forth in a written amendment executed by authorized representatives of both parties.

Approvals

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