Business Additional Application

BUSINESS ADDITIONAL APPLICATION

WHEREAS, Applicant Name: (the "Applicant") is engaged in lawful business operations and seeks to obtain additional services and terms from Company Name: (the "Company");

WHEREAS, the parties desire to supplement or amend the original application or agreement by providing further information, defining scope of work, payment terms, and other operating provisions as set forth in this Business Additional Application (the "Application");

WHEREAS, Applicant represents that the information supplied herein is accurate and authorizes the Company to rely on the representations for credit, service provisioning, and related determinations.

Business Information

Corporation    Limited Liability Company (LLC)    Partnership    Sole Proprietorship    Other:

Ownership and Key Personnel

Provide principal owners and officers. Additional sheets may be attached and signed if necessary.

Financial and Reference Information

Scope of Work

Payment Terms

Total Amount Payable:

Late Payment Fee: — Fees are calculated on outstanding balances in accordance with the schedule set forth above.

Term and Termination

Effective Start Date: . Anticipated End Date: .

Confidentiality

Each party shall maintain the confidentiality of all non-public information disclosed by the other party in connection with this Application and related transactions ("Confidential Information"). Confidential Information shall not include information that (i) is or becomes publicly available other than through breach of this clause, (ii) is rightfully received from a third party without restriction, or (iii) is independently developed without use of the other party's Confidential Information. The receiving party shall use the same degree of care to protect Confidential Information as it uses to protect its own confidential information, but in no event less than reasonable care. Disclosure may be made to employees, contractors or agents on a need-to-know basis provided such persons are bound by confidentiality obligations no less protective than those herein. Obligations under this clause shall survive termination for a period of three (3) years, or longer where required for trade secrets or other protected information under applicable law.

Governing Law

This Application, and any dispute arising out of or related to it, shall be governed by and construed in accordance with the laws of the state of , without regard to choice-of-law principles that would apply the law of another jurisdiction.

Entire Agreement and Amendments

This Application, together with any existing agreement between the Applicant and the Company expressly referenced herein, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written. No amendment or modification of this Application shall be effective unless made in writing and signed by authorized representatives of both parties.

Representations, Warranties and Certification

The Applicant represents and warrants that the information provided in this Application is true, complete and accurate as of the date signed below; that the Applicant has the full right, power and authority to enter into and perform under this Application; and that execution of this Application has been duly authorized by all necessary action. The Applicant agrees to notify the Company promptly of any material change to the information provided herein.

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