Business DSO Questionnaire

Business DSO Questionnaire

Recitals

WHEREAS, Company Name: (hereinafter the Company) conducts business and maintains accounts receivable subject to review by the Service Provider; and

WHEREAS, Service Provider Name: (hereinafter the Provider) requires detailed accounts receivable and collections information to evaluate Days Sales Outstanding (DSO) metrics and related services; and

WHEREAS, the parties desire to record the responses and related representations in this Business DSO Questionnaire to support operational review and any subsequent agreement.

Respondent Information

Accounts Receivable Summary

Total Gross Receivables (current ledger balance):

Net Receivables (after reserves/allowances):

Average DSO (most recent 12 months):    Average Monthly Sales:

Top Customer Concentration

Billing & Invoicing Practices

Standard Invoice Terms (e.g., Net 30):

Frequency of Invoicing:

Email    Postal Mail    Client Portal    EDI

Credit & Collections

Do you perform credit checks on customers?   Yes No

Do you place receivables with third-party collectors or law firms?   Yes No

Third-Party Financing / Factoring

Are any receivables currently assigned, pledged or factored?   Yes No

Reporting, Systems & Data Access

Accounting system(s) in use:

Do you permit export or read-only access to AR data for due diligence?   Yes No

Scope of Work

Payment Terms

Agreed Fee (flat or maximum):

Payment Schedule (milestones or dates):

Late Payment Fee or Interest:

Term and Termination

Term Commencement Date:    Term Expiration Date:

Termination Notice Period (days):

Termination for material breach shall permit the non-breaching party to terminate after providing written notice and a reasonable cure period as agreed above.

Confidentiality

All non-public information disclosed in connection with this questionnaire, including detailed AR records, customer data, and collection histories, is Confidential Information. The Provider shall use Confidential Information solely to perform the Scope of Work and shall not disclose such information except to employees or contractors on a need-to-know basis who are bound by confidentiality obligations no less protective than those herein.

Confidentiality exceptions: information that is or becomes publicly known through no breach by the recipient, already known without obligation of confidentiality, or lawfully obtained from a third party not under confidentiality restrictions.

Representations, Warranties & Certifications

The undersigned represents and warrants that the information provided in this questionnaire is true, complete and correct to the best of the respondent's knowledge as of the date of signature, and that no material receivable obligations are omitted. Respondent acknowledges that Provider may rely on these representations in evaluating services and structuring any engagement.

Respondent confirms that there are no undisclosed disputes with customers that would materially affect reported AR balances.

Governing Law

This Questionnaire and any subsequent agreement that incorporates it shall be governed by and construed in accordance with the laws of the state of , without regard to its conflict of laws principles.

Entire Agreement

This Questionnaire, together with any subsequent executed engagement letter or agreement that expressly incorporates it, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous communications, proposals, and agreements, whether oral or written.

Acknowledgment

By signing below, the undersigned certifies under penalty of perjury that the information provided in this Business DSO Questionnaire is accurate and complete, and that the signatory has authority to bind the named party.

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