Version 2026-05-30. Provider applicants must review and agree before submitting the network application.
This agreement is linked from the provider signup form and is accepted electronically through the required application checkbox.
# PROVIDER/CONTRACTOR AGREEMENT
## NATIONAL SITE RENTAL LLC
### Provider Network Agreement
**Version:** 2026-05-30
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This Provider Network Agreement ("Agreement") is entered into as of the date Provider accepts this Agreement electronically or the date last signed below, as applicable ("Effective Date"), by and between:
**National Site Rental LLC**, a Michigan limited liability company ("NSR"), and
**[Provider Legal Name]**, a [entity type, e.g., sole proprietorship / LLC / corporation] organized in the State of [State] ("Provider").
NSR and Provider are each referred to individually as a "Party" and collectively as the "Parties."
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## RECITALS
WHEREAS, NSR markets, brokers, and coordinates portable restroom, restroom trailer, dumpster, and related site-service requests between customers and independent local providers;
WHEREAS, Provider operates a portable restroom, dumpster rental, hauling, or related site-service business within a defined service area;
WHEREAS, NSR desires to include Provider in its non-exclusive provider network and coordinate potential customer service opportunities with Provider on the terms set forth herein;
NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein, and for other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the Parties agree as follows:
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## SECTION 1 — PURPOSE AND SCOPE
**1.1 NSR Role.** NSR operates as a broker, marketer, coordinator, and marketplace facilitator. NSR does not own, operate, deliver, service, or remove portable restroom units, restroom trailers, dumpsters, vehicles, or related equipment. NSR markets to customers, collects customer requests, coordinates provider pricing and availability, sets customer-facing pricing, and may assign approved work orders to qualified providers in its network.
**1.2 Provider Role.** Provider is an independent operator responsible for furnishing all labor, equipment, vehicles, materials, permits, licenses, insurance, supervision, and expertise necessary to perform any work order Provider accepts.
**1.3 No Guarantee of Work.** Enrollment in the NSR provider network does not guarantee any number of requests, jobs, orders, customers, revenue, territory, ranking, or exclusivity.
**1.4 No Exclusivity.** This Agreement is non-exclusive. NSR may work with any number of providers in the same geographic area. Provider may continue to operate independently and accept business from any other source, subject to the confidentiality and non-circumvention obligations in this Agreement.
**1.5 Work Order Controls.** Each assigned job will be governed by this Agreement and the applicable written NSR work order. If there is a conflict between this Agreement and a work order, this Agreement controls unless the work order expressly states that it overrides a specific section of this Agreement.
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## SECTION 2 — SERVICE AREA, EQUIPMENT, AND PROVIDER INFORMATION
**2.1 Service Area.** Provider shall identify the zip codes, counties, cities, or regions it is willing and able to serve. Provider is responsible for keeping its service area accurate and promptly notifying NSR of temporary or permanent capacity changes.
**2.2 Equipment and Services.** Provider shall identify the equipment and services it offers, including applicable sizes, unit types, service frequencies, delivery limitations, disposal restrictions, and any seasonal or operational constraints.
**2.3 Provider Information.** Provider represents that all information submitted to NSR is accurate and complete. Provider shall promptly update NSR regarding material changes to ownership, contact information, insurance, licensing, capacity, rates, service area, or equipment availability.
**2.4 Marketing Use.** NSR may refer generally to Provider as part of the NSR provider network and may use Provider's company name, service area, equipment categories, and non-confidential business information for network, dispatch, and customer coordination purposes. NSR shall not use Provider's logo in public marketing materials without Provider's consent.
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## SECTION 3 — PRICING, QUOTES, AND PAYMENT MODEL
**3.1 Provider Rates.** Provider shall submit its rates, fees, minimum charges, delivery charges, disposal charges, fuel surcharges, environmental fees, service fees, cancellation fees, overage fees, damage fees, rental periods, and any other charges applicable to Provider's services. Provider is responsible for clearly identifying all charges that may apply.
**3.2 Customer-Facing Pricing.** NSR sets customer-facing pricing independently. Provider shall not disclose Provider rates to NSR customers or attempt to alter NSR's customer-facing pricing.
**3.3 Rate Changes.** Provider shall give NSR written notice of rate changes before they take effect. Unless NSR agrees otherwise in writing, rate changes do not apply to already-accepted work orders or customer-approved pending orders.
**3.4 Quote Validity.** Unless otherwise stated in writing, Provider pricing and availability quoted to NSR for a specific opportunity must remain valid for at least forty-eight (48) hours or the period stated in the RFQ/work order, whichever is shorter.
**3.5 No Customer Collection.** Provider shall not collect payment, deposits, tips, additional fees, or other compensation directly from an NSR customer for an NSR-originated work order unless NSR gives prior written approval.
**3.6 Provider Rates Confidential.** Provider rates, NSR pricing, margins, customer pricing, and related commercial terms are Confidential Information under Section 11.
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## SECTION 4 — RFQS, WORK ORDERS, AND FULFILLMENT
**4.1 Redacted RFQs.** NSR may first send Provider a redacted request for pricing and availability ("RFQ") that includes limited job details and excludes customer-identifying information. An RFQ is not a work order and does not obligate either Party to proceed.
**4.2 Work Order Assignment.** If a customer approves the quote and NSR assigns the job to Provider, NSR will send Provider a written work order containing job-specific details. Provider may accept or decline offered RFQs and work orders in its discretion before Provider commits. Provider must accept or decline the work order within the timeframe specified by NSR. Failure to respond within that timeframe may be treated as a decline.
**4.3 Accepted Work Orders.** Once Provider accepts or commits to a work order, Provider is responsible for completing it according to the work order, this Agreement, and applicable law. Provider shall not materially change delivery date, pickup date, equipment type, quantity, service frequency, placement, or pricing without NSR's written approval. Valid reasons for non-performance may include unsafe site conditions, materially incorrect information, emergency, blocked access, permit or legal issue, prohibited materials, customer-caused problem, severe weather, force majeure, or another issue NSR determines in good faith is legitimate.
**4.4 Professional Standards.** Provider shall perform accepted work orders in a professional and workmanlike manner, including:
- (a) delivering clean, sanitary, safe, and working equipment;
- (b) completing delivery, servicing, relocation, and pickup on the dates and times confirmed;
- (c) using qualified, properly licensed, and properly supervised personnel;
- (d) complying with all applicable federal, state, and local laws, rules, ordinances, permit requirements, safety standards, transportation rules, waste-disposal requirements, and environmental requirements;
- (e) promptly notifying NSR of delays, access issues, service failures, damage, accidents, customer complaints, or conditions that may affect performance; and
- (f) treating customers, property owners, general contractors, event staff, inspectors, and other site contacts professionally.
**4.5 Subcontracting.** Provider shall not subcontract an NSR work order without NSR's prior written approval. If approved, Provider remains fully responsible for the subcontractor's work, conduct, insurance, licensing, safety, and compliance.
**4.6 Site Conditions and Access.** Provider shall promptly notify NSR if site conditions, access limitations, unsafe conditions, blocked equipment, prohibited materials, overweight loads, permit issues, or customer instructions may create additional charges, delays, or safety risks. Provider shall not impose additional charges on an NSR customer directly.
**4.7 Provider Ranking and Suspension.** NSR may rank, prioritize, pause, suspend, or remove providers based on pricing, availability, responsiveness, insurance status, service quality, customer feedback, no-shows, safety issues, claims history, or other business factors determined by NSR.
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## SECTION 5 — LICENSING, COMPLIANCE, AND REPRESENTATIONS
**5.1 Licenses and Permits.** Provider represents and warrants that it holds, and will maintain, all licenses, permits, registrations, authorizations, and approvals required to perform its services in each jurisdiction where it accepts work.
**5.2 Legal Compliance.** Provider shall comply with all applicable laws and regulations, including those relating to sanitation, waste hauling, transportation, occupational safety, employment, independent contractors, environmental protection, disposal, accessibility, and consumer protection.
**5.3 Equipment Condition.** Provider represents that all equipment used for NSR work orders will be owned, leased, or lawfully controlled by Provider; suitable for the intended use; properly maintained; and compliant with applicable safety and sanitation requirements.
**5.4 No Debarment or Prohibition.** Provider represents that it is not prohibited from performing the services, has not been debarred from applicable government work in a way that would affect performance, and is not subject to any known restriction that would prevent it from fulfilling accepted work orders.
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## SECTION 6 — INSURANCE
**6.1 General Liability Insurance.** Provider shall maintain commercial general liability insurance with minimum limits of $1,000,000 per occurrence and $2,000,000 aggregate, or higher limits if required by law or a specific work order.
**6.2 Commercial Auto Insurance.** Provider shall maintain commercial automobile liability insurance covering all vehicles used in performance of services, with minimum limits of $1,000,000 combined single limit per accident, or higher limits if required by law or a specific work order.
**6.3 Workers' Compensation.** Provider shall maintain workers' compensation insurance as required by applicable law for Provider's employees. If Provider is exempt from workers' compensation requirements, Provider shall provide evidence of exemption upon request.
**6.4 Additional Coverage.** If applicable to Provider's services, Provider shall maintain pollution liability, umbrella/excess liability, cargo, or other coverage reasonably requested by NSR or required by a specific customer, jobsite, municipality, or work order.
**6.5 Certificates and Additional Insured.** Before activation and upon renewal, Provider shall provide certificates of insurance evidencing required coverage and naming National Site Rental LLC as an additional insured on general liability and commercial auto policies where available. Provider shall request that insurers provide at least thirty (30) days' notice of cancellation or material change where available.
**6.6 Continuous Obligation.** Failure to maintain required insurance is grounds for immediate suspension or termination.
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## SECTION 7 — PAYMENT TERMS
**7.1 Invoicing.** After completing a work order, Provider shall submit an invoice to NSR for the agreed Provider rate. Invoices must reference the NSR work order number and include sufficient detail to identify the job, service date(s), customer location by city/state or zip code, equipment type, quantity, and approved extra charges.
**7.2 Payment Timeline.** NSR shall remit payment within fifteen (15) days after receiving a valid, undisputed invoice for a completed work order, unless the applicable work order states a different payment timeline.
**7.3 Payment Conditions; Offset Rights.** NSR may withhold or offset amounts reasonably disputed, unsupported, not approved in the work order, caused by Provider breach, subject to customer chargeback/dispute, or related to claims, damages, fines, replacement-provider premiums, refund exposure, customer credits, recovery costs, or other documented costs caused by Provider's acts, omissions, non-performance, or failure to complete an accepted work order. NSR may offset such amounts against current accounts payable or future payments owed to Provider. NSR should pay undisputed portions when practical.
**7.4 Payment Method and Tax Forms.** NSR may pay by ACH, check, or another agreed method. Provider shall provide accurate payment information and a completed IRS Form W-9 before the first payment. Provider is responsible for all taxes arising from amounts paid to Provider.
**7.5 Disputed Invoices.** If NSR disputes any portion of an invoice, NSR shall notify Provider of the disputed amount and reason. NSR shall pay any undisputed portion according to the payment timeline. The Parties shall work in good faith to resolve disputes promptly.
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## SECTION 8 — CANCELLATIONS, NO-SHOWS, CHANGES, AND PERFORMANCE ISSUES
**8.1 Customer Cancellations.** Provider is entitled to cancellation compensation only if the applicable work order, written NSR approval, or mutually agreed fee schedule provides for it. NSR is not obligated to pay cancellation fees that were not approved by NSR in writing before they were incurred.
**8.2 Customer Changes and Extra Charges.**
(a) *Standard pass-through surcharges.* Provider may bill NSR for documented, customer-caused surcharges that arise in the ordinary course of service — including overweight or overloaded containers, tonnage or disposal overages, prohibited or non-permitted materials, extended rentals, additional servicing, and return trips for blocked, inaccessible, or relocated placement — without obtaining advance written approval, provided the charge is (i) at the rates stated in the applicable work order or, if not stated, Provider's standard published rates, and (ii) supported by reasonable documentation (such as scale tickets, photos, or service notes) submitted to NSR with the invoice. Provider shall notify NSR promptly when it becomes aware that a material surcharge is likely.
(b) *Other extras.* For extras that fall outside subsection (a), that are discretionary, or that materially exceed the work order amount, Provider shall obtain NSR's written approval before charging, except in emergencies where prior approval is impracticable. Provider must document any such charges.
**8.3 Provider No-Show or Failure to Perform.** If Provider fails to fulfill an accepted work order without a valid reason and without sufficient advance notice for NSR to arrange an alternative provider, Provider shall not be entitled to payment for that work order. NSR may remove Provider from the network and Provider may be responsible for reasonable documented costs NSR incurs to replace Provider or address customer impact, including replacement-provider premiums, customer credits, refunds, chargebacks, and related recovery costs.
**8.4 Repeated Performance Issues.** NSR may suspend or terminate Provider for repeated late deliveries, missed pickups, service failures, customer complaints, unsafe conduct, inaccurate availability, unapproved extra charges, failure to maintain insurance, or other performance issues.
**8.5 Cure Period.** For curable performance issues, NSR may provide Provider written notice and an opportunity to cure. NSR may suspend Provider immediately while a performance, safety, insurance, legal, or customer-impact issue is under review.
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## SECTION 9 — INDEPENDENT CONTRACTOR RELATIONSHIP
**9.1 Independent Contractor Status.** Provider is an independent contractor and not an employee, agent, partner, franchisee, joint venturer, or legal representative of NSR.
**9.2 Control of Work.** Provider controls the manner and means of performing accepted work orders, subject to the customer requirements, work order specifications, safety obligations, and quality standards in this Agreement.
**9.3 No Benefits.** Provider and Provider's personnel are not entitled to employee benefits from NSR.
**9.4 Personnel.** Provider is solely responsible for Provider's employees, contractors, subcontractors, drivers, and agents, including hiring, supervision, compensation, taxes, insurance, training, safety, and compliance with employment laws.
**9.5 No Authority to Bind.** Provider has no authority to bind NSR, make representations on NSR's behalf, modify customer pricing, waive NSR terms, or accept payment on NSR's behalf without NSR's written approval.
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## SECTION 10 — TERM AND TERMINATION
**10.1 Term.** This Agreement begins on the Effective Date and continues until terminated.
**10.2 Termination Without Cause.** Either Party may terminate this Agreement without cause upon thirty (30) days' written notice.
**10.3 Termination for Cause.** Either Party may terminate this Agreement immediately upon written notice if the other Party materially breaches this Agreement and fails to cure within fifteen (15) days after written notice, or if the other Party engages in fraud, illegal conduct, gross negligence, willful misconduct, insolvency, or conduct that creates material safety, legal, reputational, or customer risk.
**10.4 Immediate Suspension.** NSR may immediately suspend Provider from receiving RFQs or work orders while investigating insurance, safety, customer, legal, payment, or performance concerns.
**10.5 Effect of Termination.** Upon termination, NSR shall pay undisputed amounts due for completed work orders, subject to offsets and disputes allowed under this Agreement. Accepted work orders not yet completed shall be completed, reassigned, or cancelled as NSR reasonably determines in light of customer needs and Provider's termination status.
**10.6 Survival.** Sections concerning payment obligations, confidentiality, customer data, non-circumvention, indemnification, limitation of liability, dispute resolution, records, and any provisions that by their nature should survive shall survive termination.
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## SECTION 11 — CONFIDENTIALITY, CUSTOMER DATA, AND NON-CIRCUMVENTION
**11.1 Confidential Information.** "Confidential Information" means non-public information disclosed by one Party to the other in connection with this Agreement, including customer information, provider rates, NSR pricing, margins, business practices, dispatch information, work order data, customer lists, RFQs, and the terms of this Agreement.
**11.2 Confidentiality Obligations.** Each Party shall use the other Party's Confidential Information only as necessary to perform under this Agreement and shall not disclose it to third parties except to personnel, insurers, attorneys, accountants, approved subcontractors, or advisors who need to know and are bound by confidentiality obligations, or as required by law.
**11.3 Customer Data Use.** Provider shall use NSR customer information only to fulfill the specific NSR work order for which it was provided, including delivery, service, pickup, and necessary job coordination. Provider shall not use NSR customer information for marketing, upselling, future direct bookings, direct solicitation, resale, separate billing, collecting payment, bypassing NSR, or any purpose unrelated to the applicable work order.
**11.4 Non-Circumvention.** During the term of this Agreement and for twelve (12) months after each NSR customer introduction or NSR-originated work order, Provider shall not knowingly solicit, divert, or accept direct business from that NSR-originated customer for substantially similar services at the same project, site, event, account, location, or related future rental need, except through NSR or with NSR's written consent. This restriction does not apply to customers Provider can document were existing direct customers before NSR introduced the opportunity.
**11.5 Non-Circumvention Remedies.** If Provider violates the customer data or non-circumvention restrictions, NSR may remove Provider from the network, suspend pending opportunities, pursue damages, seek injunctive relief, and use any other remedies available at law or equity. The Parties do not agree to a fixed liquidated-damages amount in this Agreement.
**11.6 Data Security.** Provider shall use reasonable administrative, technical, and physical safeguards to protect customer information and shall promptly notify NSR of any actual or suspected unauthorized access, disclosure, loss, or misuse of NSR customer information.
**11.7 Exceptions.** Confidentiality obligations do not apply to information that is publicly available through no fault of the receiving Party, already known without restriction, independently developed without use of Confidential Information, or required to be disclosed by law after reasonable notice where legally permissible.
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## SECTION 12 — INDEMNIFICATION
**12.1 Provider Indemnification.** Provider shall defend, indemnify, and hold harmless NSR and its members, managers, officers, employees, contractors, representatives, customers, and agents from and against claims, damages, losses, liabilities, fines, penalties, costs, and expenses, including reasonable attorneys' fees, arising out of or related to: (a) Provider's performance or failure to perform services; (b) Provider's equipment, vehicles, personnel, subcontractors, or operations; (c) Provider's negligence, willful misconduct, unsafe conduct, or violation of law; (d) bodily injury, death, property damage, environmental contamination, waste-disposal issues, employment claims, or transportation incidents caused by Provider; or (e) Provider's breach of this Agreement.
**12.2 NSR Indemnification.** NSR shall defend, indemnify, and hold harmless Provider and its owners, officers, employees, and agents from and against claims, damages, losses, liabilities, costs, and expenses, including reasonable attorneys' fees, arising out of or related to NSR's gross negligence, willful misconduct, violation of law, or material breach of this Agreement.
**12.3 Procedure.** The indemnified Party shall promptly notify the indemnifying Party of any claim, provide reasonable cooperation, and allow the indemnifying Party reasonable control of the defense and settlement. The indemnifying Party shall not settle any claim in a way that imposes liability, admission of fault, or non-monetary obligation on the indemnified Party without the indemnified Party's prior written consent.
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## SECTION 13 — LIMITATION OF LIABILITY
**13.1 Exclusion of Certain Damages.** EXCEPT FOR EXCLUDED CLAIMS, NEITHER PARTY SHALL BE LIABLE TO THE OTHER FOR INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY, OR PUNITIVE DAMAGES ARISING OUT OF OR RELATED TO THIS AGREEMENT, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
**13.2 Liability Cap.** EXCEPT FOR EXCLUDED CLAIMS, NSR'S TOTAL CUMULATIVE LIABILITY TO PROVIDER FOR CLAIMS ARISING OUT OF OR RELATED TO THIS AGREEMENT SHALL NOT EXCEED THE GREATER OF: (A) THE TOTAL AMOUNTS PAID BY NSR TO PROVIDER IN THE THREE (3) MONTHS PRECEDING THE EVENT GIVING RISE TO THE CLAIM; OR (B) $1,000.
**13.3 Excluded Claims.** "Excluded Claims" means payment obligations for undisputed completed work orders, confidentiality breaches, customer data misuse, non-circumvention breaches, indemnification obligations, fraud, willful misconduct, gross negligence, and claims that cannot legally be limited.
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## SECTION 14 — RECORDS AND AUDIT
**14.1 Records.** Provider shall maintain accurate records relating to NSR work orders, including delivery tickets, service logs, disposal tickets, weight tickets, photographs where applicable, incident reports, customer communications, invoices, and proof of completion, for at least three (3) years.
**14.2 Delivery and Pickup Proof.** NSR may request delivery and pickup photo confirmation or other proof of completion. Provider's drivers may occasionally fail to capture photos or proof, but Provider acknowledges that lack of proof weakens Provider's ability to dispute customer claims. If a customer claims non-delivery, missed pickup, poor service, damage, or another service issue and Provider lacks supporting proof, NSR may, after good-faith investigation, side with the customer for refund, credit, chargeback, or payout-adjustment purposes.
**14.3 Documentation Requests.** Provider shall provide reasonable documentation requested by NSR to verify performance, respond to customer disputes, support billing, investigate incidents, or comply with legal obligations. NSR's good-faith investigation and decision on customer credits, refunds, chargebacks, and payout adjustments will be final for payout purposes unless clear new evidence becomes available.
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## SECTION 15 — GENERAL PROVISIONS
**15.1 Governing Law.** This Agreement shall be governed by and construed in accordance with the laws of the State of Michigan, without regard to conflict-of-laws principles.
**15.2 Dispute Resolution and Venue.** The Parties shall attempt in good faith to resolve disputes through direct negotiation. If negotiation fails, either Party may request non-binding mediation. Unless otherwise required by law, venue for litigation shall be in the state or federal courts located in Antrim County, Michigan, or the nearest Michigan court with jurisdiction if no such court is available.
**15.3 Injunctive Relief.** A breach of confidentiality, customer data, or non-circumvention obligations may cause irreparable harm. NSR may seek temporary, preliminary, or permanent injunctive relief without posting bond, in addition to any other remedies available.
**15.4 Entire Agreement.** This Agreement, together with accepted work orders and incorporated exhibits, constitutes the entire agreement between the Parties regarding the subject matter and supersedes prior or contemporaneous agreements, representations, and understandings.
**15.5 Amendments.** This Agreement may be amended only by written agreement signed or electronically accepted by both Parties. NSR may update operational policies, forms, provider requirements, insurance requirements, and dispatch procedures upon written notice, provided such updates do not materially reduce amounts owed for already-accepted work orders.
**15.6 Waiver.** No failure or delay in exercising any right constitutes a waiver.
**15.7 Severability.** If any provision is unenforceable, the remaining provisions remain in effect, and the unenforceable provision shall be modified to the minimum extent necessary to make it enforceable.
**15.8 Assignment.** Provider may not assign this Agreement or delegate work orders without NSR's prior written consent. NSR may assign this Agreement to an affiliate, successor, purchaser, or entity acquiring substantially all of NSR's assets or business.
**15.9 Notices.** Notices must be in writing and delivered by hand delivery, nationally recognized overnight courier, certified mail, or email with confirmation of transmission to the notice addresses provided by the Parties. Operational communications, RFQs, and work orders may be sent by email, text, phone, platform notification, or other ordinary dispatch methods.
**15.10 Electronic Acceptance; Clickwrap.** Provider may accept this Agreement by physical signature, electronic signature, or checking an online box indicating agreement. Provider agrees that electronic acceptance has the same legal effect as a handwritten signature and that the person accepting on Provider's behalf is authorized to bind Provider.
**15.11 Counterparts; Electronic Signatures.** This Agreement may be executed in counterparts. Electronic signatures and electronic records are valid and binding.
**15.12 Force Majeure.** Neither Party shall be liable for delays or failure to perform caused by circumstances beyond its reasonable control, including acts of God, extreme weather, natural disasters, government actions, labor disruptions, supply shortages, utility failures, war, terrorism, epidemics, or transportation disruptions, provided the affected Party gives prompt notice and uses reasonable efforts to resume performance. Force majeure does not excuse payment obligations for completed work.
**15.13 Interpretation.** Headings are for convenience only. "Including" means "including without limitation." This Agreement shall not be construed against either Party solely because that Party drafted it.
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## SIGNATURE / ACCEPTANCE BLOCK
Provider may accept this Agreement electronically through NSR's provider signup form or by signing below.
**NATIONAL SITE RENTAL LLC**
Signature: ________________________________
Printed Name: ________________________________
Title: ________________________________
Date: ________________________________
Email for Notices: ________________________________
Address: ________________________________
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**PROVIDER**
Business Legal Name: ________________________________
Signature: ________________________________
Printed Name: ________________________________
Title: ________________________________
Date: ________________________________
Email for Notices: ________________________________
Business Address: ________________________________
Phone: ________________________________
State of Incorporation/Organization: ________________________________
Federal EIN or SSN (for 1099 purposes): ________________________________
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## EXHIBIT A — PROVIDER SERVICE AREA, EQUIPMENT, AND RATES
*To be completed by Provider during enrollment or onboarding.*
**Designated Service Area:**
Zip Codes: ________________________________________________________________
Counties/Cities/Regions: ___________________________________________________
**Equipment / Services Offered:**
- [ ] Standard Portable Restroom
- [ ] ADA-Compliant Portable Restroom
- [ ] Flushable/Luxury Portable Restroom
- [ ] Restroom Trailer (specify sizes): ________________________
- [ ] Handwash Station
- [ ] Holding Tank
- [ ] Roll-Off Dumpster (specify sizes): ________________________
- [ ] Other: ________________________
**Provider Base Rates / Fees:**
| Equipment / Service | Base Rate | Included Rental Period / Service Frequency | Extra Fees / Notes |
|---------------------|-----------|--------------------------------------------|--------------------|
| | | | |
| | | | |
| | | | |
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## EXHIBIT B — PAYMENT INFORMATION
*To be collected securely during onboarding. Do not attach sensitive bank information to widely shared copies of this Agreement.*
Preferred Payment Method: [ ] ACH [ ] Check [ ] Other: ______________________
Account Holder Name: ________________________________
Payment Contact Email: ________________________________
W-9 Received: [ ] Yes [ ] No
COI Received: [ ] Yes [ ] No
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*END OF AGREEMENT*
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*Version 2026-05-30 | National Site Rental LLC*