Vehicle Trailer Application Form

Vehicle Trailer Application Form and Services Agreement

Applicant Name:   Provider Name:

WHEREAS

WHEREAS, Applicant seeks approval to register, access, or procure services related to the operation, storage, maintenance, or modification of the vehicle trailer described herein; and

WHEREAS, Provider is engaged in the provision of trailer registration, storage, maintenance, and related administrative services and is authorized to accept and adjudicate applications under the terms set forth in this document; and

WHEREAS, the parties desire to set forth the scope of services, payment terms, confidentiality obligations, and governing law that will apply to the Applicant's trailer application and any ancillary services provided by Provider.

Applicant Contact Information

Trailer Details

VIN:   Make:   Model:

Year:   Type:   Gross Weight (lbs):

Length (ft):   License/Plate No.:   Registration State:

Clear Title    Lien Recorded    Salvage/Rebuilt

Scope of Work

Describe requested services, storage requirements, registration assistance, maintenance, or modifications to be provided under this application:

Insurance and Compliance

Is the trailer insured to the minimum coverage required by applicable law?   Yes    No

Payment Terms

Application Fee Amount: $   Service Fee (if applicable): $

Payment Schedule:

Late Fee:

All fees are non-refundable unless otherwise expressly agreed in writing. Applicant agrees to reimburse Provider for reasonable collection costs, including attorneys' fees, for unpaid balances.

Term and Termination

Effective Date:   Term End Date:

Either party may terminate this Agreement for convenience by providing written notice to the other party at least days prior to the intended termination date. Provider may suspend services immediately if Applicant fails to maintain required insurance or fails to pay fees when due.

Confidentiality

Each party shall treat as confidential all non-public information disclosed by the other party in connection with this application and any services provided hereunder ("Confidential Information"). Confidential Information does not include information that (i) is or becomes publicly available other than through breach of this Agreement, (ii) was already in the receiving party's lawful possession without restriction, or (iii) is rightfully received from a third party without breach of any obligation of confidentiality. The receiving party may disclose Confidential Information to the extent required by law or by a valid order of a court or governmental authority, provided the receiving party uses reasonable efforts to notify the disclosing party promptly to permit it to seek protective relief.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflict of laws principles. The parties submit to the exclusive jurisdiction of the state and federal courts located in the chosen state for resolution of disputes arising under this Agreement.

Entire Agreement

This document, together with any separate written fee schedules or appendices executed by the parties, constitutes the entire agreement between Applicant and Provider with respect to the subject matter hereof and supersedes all prior oral or written agreements, representations and understandings. No amendment or waiver shall be effective unless in writing and signed by both parties.

Certifications and Applicant Representations

Applicant certifies under penalty of perjury that the information provided in this application is true, complete and accurate to the best of Applicant's knowledge. Applicant agrees to provide documentation of title, registration, insurance, and any other records reasonably requested by Provider to verify information submitted in this application.

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