Product Acknowledgement Form

PRODUCT ACKNOWLEDGEMENT FORM

This Product Acknowledgement Form is entered into as of between the parties identified below.

WHEREAS

WHEREAS, Supplier manufactures or distributes the product(s) described in this form and has agreed to deliver such product(s) to Recipient pursuant to an applicable purchase order or agreement identified as ;

WHEREAS, Recipient requires documented acknowledgement of product condition, configuration, and acceptance criteria at the time of delivery and inspection; and

WHEREAS, the parties intend this Product Acknowledgement Form to record delivery, inspection results, and related payment and confidentiality obligations.

PRODUCT DETAILS

Product 1 — Description: Serial / Model:

Product 2 — Description: Serial / Model:

Additional items or attachments:

SCOPE OF WORK / DELIVERY & INSPECTION

Delivery Date: Inspection Complete By:

Acceptance Result: Passed Failed If failed, corrective action required:

PAYMENT TERMS

Total Amount Due:

Late Payment Fee: Invoice Reference:

TERM AND TERMINATION

Term Commencement: Term Expiration:

Either party may terminate this acknowledgement for material breach if the breaching party fails to cure within the notice period above. Termination does not relieve the parties of payment obligations accrued prior to termination.

CONFIDENTIALITY

Each party acknowledges that information exchanged in connection with the product, delivery, technical specifications, testing results, and pricing constitutes Confidential Information. The recipient shall: (a) restrict disclosure to personnel with a need to know; (b) use such information solely to perform its obligations under this acknowledgement; and (c) exercise at least the same degree of care used to protect its own confidential information, but no less than reasonable care.

Exceptions: Confidential Information does not include information that is or becomes generally available to the public through no breach by the recipient, is already known by recipient without obligation of confidentiality, or is independently developed by recipient. Disclosure required by law or valid order is permitted only after providing prompt written notice to the disclosing party to allow for protective measures.

Acknowledgement of Confidentiality Obligations: Recipient acknowledges and agrees to the confidentiality obligations set forth above.

GOVERNING LAW

This Product Acknowledgement Form shall be governed by and construed in accordance with the laws of the State of , without regard to conflict of laws principles. Venue for any dispute arising out of or relating to this document shall be in the state or federal courts located in that State.

ENTIRE AGREEMENT

This Product Acknowledgement Form, together with any referenced purchase order or written amendments signed by both parties, constitutes the entire agreement between Supplier and Recipient with respect to the product delivery and acceptance described herein, and supersedes all prior or contemporaneous understandings, representations, or agreements, whether written or oral. Any modification must be in writing and signed by authorized representatives of both parties.

REPRESENTATIONS & CERTIFICATION

By signing below, each party represents and warrants that it has the authority to enter into this acknowledgement, that the information provided herein is true and correct to the best of its knowledge, and that the person signing on its behalf is an authorized representative.

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