Business Fictitious Name

BUSINESS FICTITIOUS NAME REGISTRATION AND AGREEMENT

WHEREAS

Applicant Name:

WHEREAS, Applicant intends to transact business using the fictitious business name: Fictitious Name: for the purpose of conducting business described below; and

WHEREAS, Applicant and Authorized Representative desire to record the foregoing fictitious business name, to set forth the terms for registration assistance and payment of fees, and to confirm certain covenants and certifications set forth in this Agreement.

BUSINESS DETAILS

Individual Corporation LLC Partnership Other

SCOPE OF WORK

The Authorized Representative will prepare and file the necessary documentation to register the fictitious business name in the county listed above, and will advise Applicant on procedural requirements. Specific services include:

PAYMENT TERMS

Applicant agrees to pay Authorized Representative for services and filing fees as follows.

All fees payable under this Agreement are due when invoiced. In the event Applicant fails to pay undisputed amounts within the time specified, Authorized Representative may suspend performance until all outstanding amounts are paid. Applicant shall be responsible for any collection costs, including reasonable attorney fees, incurred to collect overdue amounts.

TERM AND TERMINATION

This Agreement is effective as of the Effective Date below and shall continue until completion of the services described in Scope of Work or until terminated as provided herein. Effective Date:

Term End Date (if applicable): . Either party may terminate this Agreement for convenience upon written notice to the other party not less than days prior to termination. Termination shall not relieve Applicant of obligations to pay fees for services already rendered or expenses incurred.

CONFIDENTIALITY

Each party agrees that all nonpublic information disclosed by the other party in connection with this Agreement, including trade secrets, business plans, financial information and client lists, shall remain confidential and shall not be disclosed to third parties except as required by law or with the prior written consent of the disclosing party. The obligations in this clause shall survive termination of this Agreement for a period of three (3) years.

REPRESENTATIONS AND CERTIFICATION

Applicant represents and certifies that all information provided in this form is true, correct and complete to the best of Applicant's knowledge. Applicant understands that knowingly registering a fictitious business name containing false information may subject Applicant to civil or criminal penalties.

Applicant further certifies that the Applicant is the true owner of the business and that the use of the fictitious name is not for fraudulent purpose. State of registration: .

GOVERNING LAW; ENTIRE AGREEMENT

This Agreement shall be governed by and construed in accordance with the laws of the State: , without regard to its conflict of laws principles. This Agreement constitutes the entire understanding between the parties with respect to the subject matter herein and supersedes all prior negotiations and agreements, whether written or oral. No amendment shall be effective except in a written instrument signed by both parties.

NOTICES

Notices under this Agreement shall be in writing and shall be deemed given when delivered personally, sent by certified mail, or sent by nationally recognized overnight courier to the addresses listed below or to such other address as a party may designate by notice to the other.

ACKNOWLEDGMENT

By signing below, Applicant certifies under penalty of perjury under the laws of the State specified above that the information provided on this form is true and correct and that Applicant is authorized to use the fictitious name identified herein. Applicant authorizes Authorized Representative to submit the registration documents on Applicant's behalf and to receive notices relating to the filing.

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