Industrial Application Form

INDUSTRIAL APPLICATION AND SERVICE AGREEMENT

Applicant Information

Corporation LLC Partnership Sole Proprietor Other

Recitals

WHEREAS, Applicant Name: (the "Applicant") seeks approval to undertake industrial activities and obtain services described in this Application and Agreement; and

WHEREAS, Service Provider: (the "Provider") is authorized to provide industrial services, facility access, and related support on the terms set forth below.

NOW, THEREFORE, in consideration of the mutual covenants and promises contained herein, the parties agree as follows.

Scope of Work

Describe proposed services, operations, and deliverables. Include locations, phases, and measurable outcomes.

Project Details

Hazardous materials to be used on site: Yes No

Payment Terms

The Applicant shall pay the Provider for services rendered according to the following terms.

All invoiced amounts unpaid after the due date shall bear the agreed late fee and collection costs, and Provider may suspend services if payments are delinquent beyond thirty (30) days, subject to applicable notice requirements herein.

Term and Termination

The initial term of this Agreement shall commence on Start Date: and continue until End Date: unless earlier terminated as provided below.

Either party may terminate this Agreement for convenience upon written notice to the other party delivered at least days prior to the effective date of termination. Termination for cause may be effected upon material breach if such breach remains uncured for thirty (30) days after written notice.

Confidentiality

Each party shall maintain in strict confidence all non-public information designated as confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure ("Confidential Information"). Confidential Information shall not include information that is (i) already known to the receiving party without obligation of confidentiality, (ii) becomes publicly known without breach, or (iii) is rightfully received from a third party without restriction. The receiving party shall use Confidential Information solely for performance of this Agreement and shall limit disclosure to employees and contractors with a need to know who are bound to confidentiality obligations at least as protective as those herein.

Acknowledgement: Applicant and Provider acknowledge and agree to these confidentiality obligations.

Compliance; Insurance

Applicant shall at all times conduct operations in compliance with applicable laws, regulations, permits and ordinances relating to environmental protection, worker safety, fire codes, and hazardous materials. Applicant shall furnish certificates of insurance evidencing commercial general liability, automobile liability, workers' compensation, and pollution liability coverage as required by Provider prior to commencement of work.

Representations and Warranties

Each party represents and warrants that it has the full corporate power and authority to enter into this Agreement and perform its obligations hereunder, that performance will not violate any agreement or law, and that all information provided in this Application is true, complete and not misleading. Applicant agrees to promptly disclose any material change in operations or ownership that may affect Provider’s risk assessment.

Governing Law; Dispute Resolution

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to conflict of law principles. The parties shall seek in good faith to resolve disputes through negotiation; if unresolved, disputes shall be resolved in the state or federal courts located in the same state.

Entire Agreement

This Agreement, together with any exhibits and attachments expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior proposals, representations, and agreements, whether written or oral. Any amendment must be in writing and signed by both parties.

Certification

The undersigned certifies under penalty of perjury that the information contained in this Application is true, correct and complete, and that the undersigned is authorized to bind the Applicant to the terms of this Agreement.

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