Supplier Business Application Form

SUPPLIER BUSINESS APPLICATION FORM

This Supplier Business Application Form, together with the terms and conditions set forth below, constitutes an application and binding agreement between the Purchaser and the Supplier upon execution by both parties. Completion and signature of this form authorizes Purchaser to evaluate Supplier's qualifications for the supply of goods and/or services and establishes the basic commercial and legal terms under which the parties may transact business.

Recitals

WHEREAS, Purchaser desires to engage qualified vendors to supply goods and/or services and requires verification of Supplier financial, operational and compliance information; and

WHEREAS, Supplier seeks to provide goods and/or services to Purchaser and attests to the accuracy of the information provided herein and agrees to the terms set forth in this application and agreement; and

WHEREAS, the parties intend that completion and execution of this form will govern the basic business relationship unless otherwise superseded by a separate written purchase order or contract signed by both parties.

Applicant (Supplier) Information

Corporation    LLC    Partnership    Sole Proprietor    Other:

Business Operations

Typical lead time from order to shipment:    Minimum order quantity / value:

Samples available upon request:    Can you OEM/Private label products:

Financial & Payment Information

ACH/Direct Deposit    Wire Transfer    Check    Credit Card

Scope of Work

The Supplier shall provide the goods and/or services described below in accordance with Purchaser specifications and accepted purchase orders. The parties agree that the specific deliverables, schedule, quality standards and acceptance criteria shall be set forth in purchase orders, statements of work, or attachments executed under this application.

Payment Terms (Contractual)

Contract price, when applicable: $. Payment shall be made in accordance with the schedule set forth below unless otherwise agreed in writing.

Standard invoice payment terms (net days): . Late payments shall be subject to a late fee of % per month on the unpaid balance, or the maximum permitted by law, whichever is less.

Term and Termination

This Agreement shall commence on the Effective Date specified below and continue until the End Date specified below, unless earlier terminated in accordance with this section.

Effective Date:    End Date (if applicable):

Either party may terminate this Agreement for convenience upon days' written notice. Either party may terminate immediately for material breach that remains uncured for thirty (30) days after written notice of such breach.

Confidentiality

Supplier shall hold in strict confidence all non-public information disclosed by Purchaser, including pricing, specifications, designs, technical data, forecasts and business plans ("Confidential Information"). Supplier shall not disclose Confidential Information to third parties except as necessary for performance and shall use at least the same degree of care to protect Confidential Information as it uses to protect its own confidential information, but in no event less than reasonable care. Confidential Information shall not include information that is or becomes publicly known through no fault of Supplier or is independently developed without use of the Purchaser's Confidential Information.

Insurance, Licenses & Compliance

Supplier certifies that it maintains applicable licenses and permits required to perform its obligations and agrees to maintain insurance coverage customary for its industry, including commercial general liability and product liability where applicable. Supplier shall furnish certificates of insurance upon request.

Trade References

Representations & Certifications

By signing below, Supplier certifies that the information provided in this application is true, complete and correct to the best of Supplier's knowledge; Supplier will promptly notify Purchaser of any material change; and Supplier agrees to comply with Purchaser's applicable policies and lawful directions when performing services or supplying goods.

Supplier acknowledges and authorizes Purchaser to verify any information provided, including credit, banking and trade references, and to conduct such background checks as Purchaser deems necessary.

I hereby certify that the information provided is accurate and complete and that I have authority to bind the Supplier to this application and the attached terms.

Governing Law & Entire Agreement

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to conflict of law principles. Any dispute arising out of or relating to this Agreement shall be resolved in the courts located in that State, unless the parties agree otherwise in writing.

This document, together with any referenced purchase orders or written agreements executed by authorized representatives of both parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior oral and written understandings and communications.

Additional Attachments

Attach copies of relevant certificates, insurance declarations, licenses and product data sheets as applicable.

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