Business Filing Report

BUSINESS FILING REPORT

This Business Filing Report (the "Report") is made as of by and between Reporting Party: and Subject Entity: .

WHEREAS

WHEREAS, Reporting Party has undertaken to prepare, compile and deliver filings, notices, and related documentation necessary to satisfy statutory or regulatory filing obligations on behalf of the Subject Entity in the jurisdiction of ;

WHEREAS, the parties desire to memorialize the specific filings completed, the dates of filing, associated fees, and any outstanding matters requiring further action as set forth in this Report.

BUSINESS INFORMATION

LLC    Corporation    Partnership    Other:

FILING DETAILS

Date Filed:     Effective Date (if different):

Attachments Included: (Check if filed documents or receipts are attached to this Report)

SCOPE OF WORK

PAYMENT TERMS

Late Fee:     Collection Costs Recoverable:

TERM AND TERMINATION

Term Commencement Date:     Term Expiration Date:

Either party may terminate this Report for material breach by the other party if the breaching party fails to cure within the notice period set forth above. Termination shall not relieve either party of obligations accrued prior to termination, including payment obligations.

CONFIDENTIALITY

The parties acknowledge that in connection with the preparation and filing of the matters reported herein, confidential and proprietary information may be exchanged. Each party agrees to hold confidential information in strict confidence, to use such information only to perform obligations under this Report, and to disclose such information only to those employees, agents or contractors with a need to know and subject to confidentiality obligations no less protective than those set forth herein. Confidentiality obligations shall survive termination of this Report.

Acknowledgement of Confidentiality:

GOVERNING LAW

This Report 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 Report, together with any attachments or exhibits expressly incorporated 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 modification or waiver of any provision of this Report shall be effective unless in writing and signed by both parties.

CERTIFICATION

The undersigned certify, under penalty of perjury where applicable, that the information contained in this Business Filing Report is true, accurate and complete to the best of their knowledge and that all required filings and fees identified herein have been submitted as described, or that any outstanding items are identified in this Report.

Certification Acknowledged:

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