Application Fee Payment

APPLICATION FEE PAYMENT AGREEMENT

Parties

Recitals

WHEREAS, Applicant has applied to the Recipient for consideration of an application, program, license, or other service identified by Application Reference Number: , and

WHEREAS, Recipient requires payment of an application fee to process, review, or otherwise act on Applicant's application, and the parties wish to set forth the terms governing payment, acceptance, and any applicable refund or late fee rules; and

WHEREAS, the parties intend this Agreement to govern the remittance, receipt, allocation, and acknowledgement of such application fee.

Scope of Work

The application fee covers administrative review, processing, and verification activities necessary for the Recipient to evaluate Applicant's submission. Specific services and deliverables covered by the application fee are described below; any services beyond this scope will require a separate agreement and additional fees.

Payment Terms

Fee Amount: USD    Invoice / Receipt No.:

Payment Schedule: The Applicant shall pay the application fee as follows: .

Late Fee: Payments not received by the due date shall incur a late fee of , compounded monthly, unless otherwise agreed in writing.

Refund Policy: Unless otherwise expressly agreed in writing, the application fee is non‑refundable once the Recipient has commenced substantive review. Refunds, if permitted, shall be prorated to reflect services rendered and costs incurred.

Term and Termination

Effective Date: .

Termination Date (if applicable): .

Notice of Termination: Either party may terminate this Agreement by delivering written notice to the other party at least days prior to the intended termination date. Termination shall not affect obligations incurred prior to the effective date of termination.

Confidentiality

Each party shall maintain in confidence all non-public information disclosed in connection with this Agreement ("Confidential Information") and shall not disclose Confidential Information to any third party except to those employees, agents, or subcontractors with a need to know and who are bound by confidentiality obligations no less protective than those set forth herein. Confidential Information does not include information that: (a) is or becomes publicly known through no breach of this Agreement; (b) is rightfully received from a third party without restriction; (c) is independently developed without use of the other party's Confidential Information; or (d) is required to be disclosed by law, regulation, or order of a court or governmental body, provided the disclosing party gives prompt notice to the other party and cooperates in any effort to limit such disclosure.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to that State's conflicts of law principles.

Entire Agreement; Miscellaneous

This Agreement, together with any attachments or exhibits expressly incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations, and understandings of the parties. No amendment shall be effective unless in writing and signed by both parties. If any provision of this Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Acknowledgement

Applicant acknowledges that payment of the application fee is a condition precedent to initiation of the Recipient's review activities and that Applicant has read and agrees to the payment schedule, late fee provisions, and refund policy set forth in this Agreement.

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