Vendor Inquiry Form

VENDOR INQUIRY FORM & BUSINESS AGREEMENT

Parties and Identification

Client Name:

Vendor Legal Name:

Corporation LLC Partnership Sole Proprietor Other:

WHEREAS

WHEREAS, Client seeks information from potential vendors for the purpose of evaluating suppliers and negotiating a separate services agreement; and

WHEREAS, Vendor represents that it possesses the qualifications, experience, resources and insurance required to provide the goods and/or services described in this inquiry; and

WHEREAS, the parties acknowledge that this Vendor Inquiry Form may also serve as the basis for a limited business agreement governing initial engagements as set forth below.

Scope of Work (Vendor to describe services offered)

Insurance, Certifications & Attachments

Is Vendor insured? Yes No

Attachments included: W-9 or tax form Certificate of Insurance Reference List

Payment Terms

Proposed Fee:

Payment Method: Invoice Deposit Milestone payments Wire transfer / ACH

Term and Termination

Term Start Date:    Term End Date:

Either party may terminate this inquiry-based agreement upon written notice to the other if the other party materially breaches a representation, fails to cure such breach within the notice period, or becomes insolvent. Termination shall not affect accrued payment obligations or the parties' confidentiality obligations.

Confidentiality

Vendor and Client each acknowledge that during evaluations and any subsequent performance limited confidential information may be exchanged. Each party agrees to maintain the other's Confidential Information in strict confidence; to use such information solely for purposes of evaluating or performing the services described in this form; to restrict access to personnel having a need to know; and to take commercially reasonable measures to protect such information. Confidential Information does not include information that is or becomes publicly available without breach, or that is independently developed or rightfully obtained from a third party.

Governing Law; Entire Agreement

Governing Law: The construction, interpretation and enforcement of this Vendor Inquiry Form and any limited agreement arising from it shall be governed by the laws of the state of , without regard to that state's choice-of-law principles.

Entire Agreement: This document constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior written or oral communications. Any amendment must be in writing signed by authorized representatives of both parties.

Representations; Certification

Vendor represents and warrants that the information provided in this form is true, complete and accurate to the best of Vendor's knowledge, that Vendor has authority to enter into agreements on behalf of the named entity, and that Vendor will promptly notify Client of any material change to the information supplied.

Vendor certifies: I certify that the above information is accurate and complete, and that I am authorized to sign on behalf of the Vendor.

Additional Notes

By signing below, each party acknowledges that submission of this form creates a binding limited agreement for the provision of services as described herein, subject to the terms above, and that further detailed contracts may be required for ongoing engagements.

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