Address Verification Form

ADDRESS VERIFICATION FORM

RECITALS

WHEREAS: Client Name: engages Provider Name: to perform address verification services as described below.

WHEREAS: The parties desire to document the scope, payment, term, confidentiality, and governing law applicable to verification of one or more postal or residential addresses and the recordkeeping, accuracy standards, and acceptance criteria for verified data.

WHEREAS: Provider will rely on records, third-party databases, and field verification procedures to determine the deliverables and will certify results according to the standards set forth in this form.

VERIFICATION REQUEST DETAILS

Date of Requested Verification:

SCOPE OF WORK

Provider will perform the following services and produce a verification report meeting the acceptance criteria described below. Provider's obligations include reasonable inquiry, use of accredited databases where applicable, and documentation of sources relied upon.

VERIFICATION METHODS

Methods employed (check all that apply):

Database check (public or proprietary)
Postal service confirmation
Field visit / inspection
Telephone confirmation
Other (specify):

PAYMENT TERMS

Client agrees to pay Provider the fees described below in consideration for the services rendered. Provider will invoice Client according to the schedule selected.

Late payment will incur a late fee of per month on overdue amounts, and a grace period of days before accrual.

TERM AND TERMINATION

Term Commencement Date:

Term Expiration Date:

Either party may terminate for material breach if the breaching party fails to cure within days after written notice. For convenience, either party may terminate upon days' prior written notice.

CONFIDENTIALITY

Both parties acknowledge that confidential business information, personal data, and verification results may be exchanged. Each party shall: (a) hold confidential information in strict confidence; (b) use such information solely to perform obligations under this form; and (c) restrict disclosure to employees or agents who need to know and are bound by confidentiality obligations at least as protective as those herein. The obligations in this paragraph survive termination for a period of three years or as otherwise required by applicable data protection law where longer retention is mandated.

Client acknowledges responsibility for lawful collection and permitted use of any personal data submitted to Provider and will indemnify Provider for any fines or liabilities resulting from Client's failure to obtain required consents.

Acknowledgement of Confidentiality: I acknowledge and agree to the confidentiality provisions above.

GOVERNING LAW

This form and any dispute arising under it shall be governed by the laws of the State of without regard to conflict of law principles.

ENTIRE AGREEMENT

This form, together with any incorporated exhibits, schedules, or attachments explicitly referenced herein, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior representations, negotiations, or agreements, whether written or oral. No amendment will be effective unless in writing and signed by duly authorized representatives of both parties.

VERIFICATION RESULTS & CERTIFICATION

Provider certifies that, to the best of its knowledge and consistent with the methods selected above, the verification report fairly and accurately reflects the sources and conclusions used to determine the status of the address(es) listed. Provider disclaims no liability for inaccuracies in third-party source data beyond Provider's reasonable control.

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