Business Activities Form

BUSINESS ACTIVITIES FORM

Parties and Identification

Business Name:

Recitals

WHEREAS, Business Name: conducts the following commercial activities and seeks to disclose, register, or certify such activities pursuant to this form; and

WHEREAS, Recipient Entity Name: requires certain representations regarding the nature, scope, and compliance status of those activities;

WHEREAS, the parties intend for this document to (a) set forth the business activities, scope of services or operations, payment arrangements where applicable, and confidentiality obligations; and (b) serve as an agreement between the parties as to the matters addressed herein.

Business Activities

Select all activities that apply (checkboxes):

Scope of Work / Activities Description

Provide a detailed description of the activities to be undertaken, deliverables, frequency, and any material limitations or exclusions:

Payment Terms

Compensation Amount:

Late Payment Fee:

Additional payment terms or conditions (e.g., retainers, reimbursements):

Term and Termination

Effective Start Date:     Anticipated End Date:

Either party may terminate this agreement for convenience upon written notice delivered at least days prior to the intended termination date. Termination for cause may be immediate when a material breach remains uncured for a period of ten (10) days following written notice of breach, or immediately if required by law.

Confidentiality

Each party acknowledges that during the course of performance it may receive or have access to nonpublic, confidential, or proprietary information of the other party ("Confidential Information"). Except as expressly authorized in writing, the receiving party shall: (a) use Confidential Information only for the purposes set forth in this form; (b) protect Confidential Information with the same degree of care it uses to protect its own confidential information but with no less than reasonable care; and (c) not disclose Confidential Information to any third party except to employees, agents, or permitted subcontractors who have a bona fide need to know and who are bound by confidentiality obligations at least as protective as those herein.

Confidential Information does not include information that: (i) is or becomes publicly available through no breach of this document; (ii) was lawfully in the receiving party's possession prior to disclosure; (iii) is independently developed without use of the disclosing party's Confidential Information; or (iv) is required to be disclosed pursuant to applicable law, provided that the receiving party gives prompt notice to the disclosing party and cooperates to limit the disclosure where permissible.

Compliance and Certifications

The undersigned certifies that the business activities described herein comply with all applicable federal, state, and local laws, rules, and regulations, and that all necessary licenses and permits have been obtained and are current. The business agrees to notify the other party in writing within ten (10) days of any change that materially affects compliance or the ability to perform the activities described.

Governing Law; Entire Agreement

This Business Activities Form and any obligations arising hereunder shall be governed by and construed in accordance with the laws of the State of without regard to principles of conflicts of law. The parties hereby submit to the exclusive jurisdiction of the state and federal courts located within that state for resolution of disputes.

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

Notices

Notices under this agreement shall be sent to the addresses below and shall be effective upon receipt when delivered in person, by certified mail return receipt requested, or by nationally recognized overnight courier.

Acknowledgment and Signature

The individual signing below represents and warrants that they are authorized to execute this Business Activities Form on behalf of the party for which they sign, that they have read and understand the terms contained herein, and that the statements and information provided are true and correct.

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