Contract Request Form


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									This document contains a Contract Request Form to be used by any department of a
Company. This form provides space for requestor information, type of contract desired,
customer information, terms and conditions, and other vital information. This form
contains standard language commonly used in this type of form, but additional language
may be added, making it fully customizable to fit the needs of the user. Using this tool
will give the user the ability to quickly request contracts from a number of different
sources. Use this form if one wants to requests contracts from a number of sources

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                                        Contract Request Form

Date: _____________________

1.      Type of Request:
              _____ New Contract
                 _____ Renew Existing Contract
                         Date of Last Contract _______________
                 _____ Amendment
                         Number of Last Amendment _______________

2.      Contract Type (Check One):

NOTE: Required only when deviating from Company’s standard Sales Terms & Conditions.

      ____ Amendment to standard Sales Terms and Conditions (No pricing)
      ____ Resale Agreement (Non-Internet reseller)
      ____ Internet Resale Agreement (Internet resellers only)
      ____ Resale Agreement including ___________________
      ____ Other (Specify): _______________________________________________

NOTE: If specific pricing allowances are to be included, the General Manager’s written
approval of the specific terms is required.

3.      Requestor Information:
        Name: _______________________________________________
        Title: _______________________________________________
        Extension or Telephone #: _______________________________
        Fax #: _______________________________________________
        Account Manager (if different than Requestor): _______________
        Area Sales Director: ____________________________________

4.      Customer Information:

        Company Account Number(s) (list Master # and all others that apply):



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NOTE: Customer information should match current profile data in your company’s

Legal Name of Company________________________________________________
Sole Proprietorship (d/b/a)   [ ] Yes  [ ] No
Partnership                   [ ] Yes  [ ] No
Limited Partnership           [ ] Yes  [ ] No
Corporation                   [ ] Yes  [ ] No
Limited Liability Company     [ ] Yes  [ ] No
Limited Liability Partnership [ ] Yes  [ ] No

(Street Address)
(City, State, Zip Code)

5.      Contract Terms and Conditions:
        A.    Term of Agreement: Effective (Beginning) Date: __________________

        B.       Length of Agreement: (Circle One):              1 year   2 years 3 years

                                                                 Other (specify) _______
        C.       Volume and Pricing Terms

                 1.      Volume Commitment = $_______________________

                 2.      Period: from (date) to (date).

        D.       If Customer fails to achieve sales consistent with volume commitment
                 after (number) days or (number) months, Company:

                 1.      ___________ reserves the right to adjust terms unilaterally, or
                 2.      ___________ will mutually renegotiate terms with Customer.

        E.       Other pricing assumptions (Check as applicable):

                 ____ Customer agrees to designate Company as its primary source
                      (defined as a minimum of (number) percent of Customer's Product

                 ____ Customer agrees to designate Company as its exclusive source

                 ____ Other (specify): _________________________________________

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        F.       Ordering:
                 Will customer be ordering by electronic means? ____ Yes ____ No
                 If yes, How? (Circle One) XML EDI Internet Fax Other: _________

        G.       Shipping and Delivery Terms:


        H.       Stock Balancing and Returns Terms:


        I.       Returns Percent                   Fee

                 0% - ___%                         No fee

                 ___.01% - ___%                    ___%

                 ___.10% or more                   ___%

        J.       Defective/DOA Returns:



        K.       Payment Terms:

               ______Standard Terms and Conditions (Per Customer’s current terms at
               time of invoice).

               ______ Non-Standard Terms (NOTE: All non-standard payment terms
               must be approved by Credit Department).

                       ____ Pre-Pay discount of            _____%
                       ____ Early Pay discount of _____%, Net _____days
                       ____ Flooring exceptions (specify): _____________________
                       ____ Other (specify): _________________________________

6.      Other Special Terms:

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Schedule (if you have a contract administration department or need other departmental

Request contract be returned to requestor by DATE: ______________________

The contract will be presented to Customer for Review:

Signature _____________________________

Date: _________________________________

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