Bank Document Copy

BANK DOCUMENT COPY

Client Name:    Recipient Name:

Date of Submission:

WHEREAS

WHEREAS, Client requires that certain bank records and related documents be copied, collected or provided to Recipient for the limited purpose of verifying account ownership, payment history, or compliance with a transaction contemplated between the parties; and

WHEREAS, Recipient has requested copies of specific bank documents directly from Client and will rely on those copies solely for the stated purpose; and

WHEREAS, the parties wish to set forth their respective obligations, certifications and the terms under which copies of bank documents will be provided and used.

SCOPE OF DOCUMENTS PROVIDED

List of Documents Provided (select all applicable):

Bank Statement (copies for specified periods)
Voided Check
Bank Letter / Bank Confirmation
Cancelled Check
Other:

AUTHORIZATION TO VERIFY AND CERTIFICATION

Client hereby certifies that the copies of bank documents provided to Recipient are true, complete and unaltered copies of original records in Client's possession or control. Client authorizes Recipient to verify the authenticity of supplied documents with the issuing bank or financial institution as necessary to confirm account ownership or transaction history.

Bank Name:    Account Holder:

Account Number (last four digits preferred):    Routing Number:

PAYMENT TERMS

For services reasonably rendered by Recipient in copying, certifying, collecting or facilitating verification of bank documents, Client agrees to pay the following fees:

All payments are due in accordance with the Payment Schedule. Late payments shall accrue interest or late fees as specified above and may result in suspension of further document handling or release.

TERM AND TERMINATION

This agreement commences on Start Date: and, unless earlier terminated in accordance with its terms, expires on End Date: .

Either party may terminate this agreement for convenience by providing written notice to the other party not less than days prior to the effective termination date. Termination will not relieve Client of obligation to pay for work performed or documents provided prior to termination.

CONFIDENTIALITY

Each party will maintain in confidence all non-public information, copies of bank documents, and any personal financial data supplied under this agreement (collectively, Confidential Information). Recipient shall use Confidential Information only for the purposes stated herein, shall restrict access to personnel with a need to know, and shall employ reasonable safeguards to prevent unauthorized disclosure. Confidential Information does not include information that is publicly available other than through a breach of this agreement.

If Recipient is required by law or valid legal process to disclose Confidential Information, Recipient will provide prompt written notice to Client (unless prohibited) and will cooperate to limit the scope of disclosure.

RETENTION AND DESTRUCTION

Recipient will retain copies of bank documents only for as long as reasonably necessary to fulfill the Purpose and in any event not longer than days, after which Recipient will securely destroy or return the documents unless retention is required by law.

INDEMNIFICATION

Client shall indemnify, defend and hold harmless Recipient from and against any losses, claims, damages, liabilities and expenses (including reasonable attorneys' fees) arising out of or relating to Client's breach of the certifications set forth in this agreement, including but not limited to claims asserting that provided copies were fraudulent, altered, or unauthorized.

GOVERNING LAW

This agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflicts of law principles.

ENTIRE AGREEMENT

This document constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings and communications, whether written or oral. Any amendment or modification must be in writing and signed by authorized representatives of both parties.

NOTICES AND CONTACTS

CERTIFICATION

By signing below, the undersigned certify under penalty of perjury that the information and copies provided under this agreement are true, accurate and complete to the best of their knowledge. The undersigned further acknowledge that misuse or intentional misrepresentation of bank documents may give rise to civil liability or criminal penalties.

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