subject_line
Legal Contract Request
INACTIVE SUBMISSION FORM - DO NOT SUBMIT HERE
Your Name:
*
Your Email Address:
*
** Sales Contract Mgmt. Playbook - Jan 2023 **
Light Sales - Key Info
Route Sales - Key Info
Contract Templates:
Nalco Program Management Agreement Template
Non-NY Route Proposal Template
NY Region Route Proposal Template
3DT Bundled Agreement Contract Template (NEW CUSTOMERS ONLY!!!)
3D TRASAR INFORMATION
Desired Action:
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🛈
Submit New Contract (One Contract Per Submission)
Submit BID/RFP
Submit NDA (Non-Disclosure Agreement)/CDA (Confidential Disclosure Agreement)
Submit Legionella Incident Response MSA
Submit Customer Response (Contract Redlines)
Submit Non-NY Route Proposal Agreement
Request Status Update (Greater Than 15 Business Days)
Request High Priority Status (Bid/RFP/Customer Escalation)
Request Copy of Existing Contract
Submit Fully Executed Contract
Does this pertain to Water Purity Solutions (WPS)?
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Yes
No
Can a Nalco NDA/CDA template be used?
Yes
No
Purpose of the NDA/CDA - Why are the parties sharing information?
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🛈
Is Nalco disclosing confidential information?
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Yes
No
Number of Parties Involved
Mutual (Both Parties)
Unilateral (One-Way)
How long should the disclosure period be?
🛈
Division
*
Is there a Prospect#/Sold-To# associated with this NDA/CDA?
Yes
No
Nalco Template?
🛈
Yes
Did you make sure?
*
The contract contains the signature(s) of BOTH parties.
ALL pages of the contract are submitted.
PDF is being provided (JPEGs and Screenshots are unacceptable!)
Contract Status Dashboard (CHECK HERE BEFORE REQUESTING STATUS)
FOR NEW LEGAL CONTRACTS ONLY - NO OTHER DOCUMENTS SHOULD BE UPLOADED
FOR NEW LEGAL CONTRACTS ONLY. A copy of the customer-signed Incident Response Agreement must be uploaded with this submittal.
Account Type:
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Street Account
Corporate Account
District:
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IS111
IS112
IS113
IS114
IS115
IS116
IS117
IS118
IS119
IS120
IS121
IS122
IS125
IS126
IS127
IS128
IS129
IS131
IS132
IS133
IS134
IS141
IS142
IS143
IS144
IS145
IS146
IS147
IS148
IS149
WL101
WL102
WL103
WL104
WL105
WL106
WL107
WL108
WL121
WL123
WL124
WL125
WL126
WL127
WL128
WL141
WL142
WL143
WL144
WL145
WL146
WL147
WL161
WL162
WL163
WL182
WL183
WL184
WL185
WL186
WL187
WL188
TR101
TR102
TR103
TR104
MN101
MN102
MN103
MN104
MN105
MN106
MN107
NW401
NW402
RT111
RT112
RT113
RT114
RT115
RT116
RT117
RT118
RT120
RT121
RT122
RT125
RT126
RT127
RT128
RT129
RT131
RT132
RT133
RT134
RT141
RT142
RT143
RT144
RT145
RT146
RT147
RT148
RT149
RT188
TS101
TS102
TS103
TS104
RT120
RT121
RT122
Territory:
Area Vice President Name:
Corporate Account Manager Name:
Corporate Account Manager Email:
Corporate Account Name (KAM2 Code/description (i.e. CAR - Cargill):
*
Type of Agreement
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Master Service Agreement
Site Specific Agreement
Sold-To or Prospect Number:
*
Account Name:
*
Add Another?:
Yes
Sold-To or Prospect Number:
Account Name:
Sold-To or Prospect Number:
Account Name:
Sold-To or Prospect Number:
Account Name:
Sold-To or Prospect Number:
Account Name:
Add Another ?:
Yes
Sold-To or Prospect Number:
Account Name:
Sold-To or Prospect Number:
Account Name:
Sold-To or Prospect Number:
Account Name:
Sold-To or Prospect Number:
Account Name:
Covers Entire CA / All Sold To Numbers?:
*
Yes
No
Sold-To Number(s)
Sold-To #:
Sold-To Number(s)
Sold-To #:
Sold-To Number(s)
Sold-To #:
Sold-To Number(s)
Sold-To #:
Sold-To Number(s)
Sold-To #:
Sold-To Number(s)
Sold-To #:
Sold-To Number(s)
Sold-To #:
Sold-To Number(s)
Sold-To #:
Sold-To Number(s)
Sold-To #:
Sold-To Number(s)
Sold-To #:
Sold-To Number(s)
Account Name(s)
Account Name:
Account Name(s)
Account Name:
Account Name(s)
Account Name:
Account Name(s)
Account Name:
Account Name(s)
Account Name:
Account Name(s)
Account Name:
Account Name(s)
Account Name:
Account Name(s)
Account Name:
Account Name(s)
Account Name:
Account Name(s)
Account Name:
Account Name(s)
Bid Due Date:
*
+
Is this contract submittal related to a Legionella Incident Response scenario? If so, the fully executed Legionella Incident Response MSA must be attached below.
🛈
Yes
No
Estimated Contract Effective Date
*
🛈
+
Estimated Contract End Date
*
+
Contract Effective Start Date
(Should coincide with Scope of Work date of service...If not, please provide explanation below)
:
*
🛈
+
Contract End Date:
*
+
Estimated Annual Value:
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Contract Number
(provided in confirmation email after submittal):
*
Contract Number:
Sold to #:
*
Account Name #1:
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Account Address #1:
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Account City #1:
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Account State #1:
*
Account Zip Code #1:
*
Add Another?:
Yes
Account Name #2:
*
Account Address #2:
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Account City #2:
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Account State #2:
*
Account Zip Code #2:
*
Add Another?:
Yes
Account Name #3:
*
Account Address #3:
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Account City #3:
*
Account State #3:
*
Account Zip Code #3:
*
Account Name #4:
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Account Address #4:
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Account City #4:
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Account State #4:
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Account Zip Code #4:
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Account Name #5:
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Account Address #5:
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Account City #5:
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Account State #5:
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Account Zip Code #5:
*
Account Name #6:
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Account Address #6:
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Account City #6:
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Account State #6:
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Account Zip Code #6:
*
Account Name #7:
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Account Address #7:
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Account City #7:
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Account State #7:
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Account Zip Code #7:
*
Account Name #8:
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Account Address #8:
*
Account City #8:
*
Account State #8:
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Account Zip Code #8:
*
Account Name #9:
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Account Address #9:
*
Account City #9:
*
Account State #9:
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Account Zip Code #9:
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Account Name #10:
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Account Address #10:
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Account City #10:
*
Account State #10:
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Account Zip Code #10:
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Is this an Institutional account?:
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Yes
No
Are the anticipated annual sales and/or services less than $100,000 per year?:
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Yes
No
Is the customer a corporate account?:
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Yes
No
Is the contract relating to a construction project?:
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Yes
No
Is the end user of Nalco Water products/services a data center?:
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Yes
No
Do we currently have a master agreement with this customer?:
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Yes
No
Are the products and/or services related to a Water Safety Incident Response or Outbreak of Legionnaires Disease?:
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Yes
No
Are the products and/or services for HVAC or Boilers including PAC 2, PAC 3, PAC 8, Legionella testing, on-line disinfection (for non-potable applications), cooling tower inspections or cooling tower cleaning and disinfection?:
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Yes
No
Do the Nalco products include a Water Management Safety Plan or application for the treatment of potable/domestic water or treatment of wastewater?:
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Yes
No
Are you using the downloaded Nalco Water Program Management Agreement?:
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Yes
No
Is this an amendment to an existing contract?:
Yes
No
Attach Original Contract:
*
Has a Scope of Work been provided?
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🛈
Yes
No
Is scope (including general disclaimer) included in the contract?:
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🛈
Yes
No
Scope Attachment:
*
🛈
Is your customer requesting non-standard billing?:
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Yes
No
Select all that apply:
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EDI (Electronic Data Interchange)
Electronic Transactions
Email
Work Order Management System (i.e. Corrigo, Facilities 360, etc.)
Is the contract?
🛈
Nalco Contract Template (Thank you for using our template!)
Subcontract/Mechanical Agreement
Please provide customer's email address for electronic signature
(if applicable)
.
🛈
Special Instructions/Comments:
*
File Upload 1:
*
Add Another File?:
Yes
File Upload 2:
Add Another File?:
Yes
File Upload 3:
Add Another File?:
Yes
File Upload 4:
Add Another File?:
Yes
File Upload 5:
NOTE: IF ANY INFORMATION RELATIVE TO THE CONTRACT IS MISSING (i.e. SCOPE OF WORK, PRICING, EXHIBITS, ETC.), IT WILL BE REJECTED WHICH WILL FURTHER DELAY THE REVIEW PROCESSING TIME.