Business Information Needed

BUSINESS INFORMATION NEEDED

Client Name:     Service Provider Name:

Effective Date:

Recitals

WHEREAS, Client is engaged in lawful business operations and requires certain professional services and information to be provided by Service Provider in connection with Client’s operations; and

WHEREAS, Service Provider possesses the necessary expertise and will provide the scope of services described below in exchange for the consideration and under the terms set forth in this Agreement; and

NOW, THEREFORE, in consideration of the mutual covenants and promises herein contained, the Parties agree as follows.

Business Identification

Corporation    Limited Liability Company (LLC)    Partnership    Sole Proprietorship    Other

Scope of Work

Service Provider shall perform the services described below for Client in a professional and workmanlike manner and in accordance with any milestones and deliverables agreed by the Parties.

Payment Terms

Compensation shall be as set forth below. Client shall pay Service Provider in accordance with the schedule and amounts identified.

If any payment is not received by the due date, interest will accrue at the lesser of (i) the maximum rate permitted by applicable law, or (ii) and Client shall be responsible for all collection costs, including reasonable attorneys’ fees.

Term and Termination

This Agreement shall commence on the Start Date below and shall continue until the End Date below unless earlier terminated in accordance with this Agreement.

Start Date:

End Date:

Confidentiality

Each Party (the "Receiving Party") shall maintain in confidence all non-public information disclosed by the other Party (the "Disclosing Party") that is designated as confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure ("Confidential Information"). Confidential Information excludes information that: (a) is or becomes publicly known through no breach of this Agreement by the Receiving Party; (b) is rightfully received from a third party without restriction; (c) is independently developed by the Receiving Party without use of the Disclosing Party’s Confidential Information; or (d) is required to be disclosed by law or valid legal process provided the Receiving Party gives prompt notice and cooperates to seek protective measures.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the state identified below, without regard to conflict of law principles. The Parties consent to the exclusive jurisdiction of the courts located in that state for any dispute arising under this Agreement.

Entire Agreement

This Agreement, together with any exhibits, schedules and attachments expressly incorporated herein, constitutes the complete and exclusive statement of the terms of the agreement between the Parties with respect to its subject matter and supersedes all prior proposals, negotiations, agreements and other communications, whether oral or written. Any amendment or modification must be in writing and signed by authorized representatives of both Parties.

Certifications and Authorizations

The undersigned certifies that they are duly authorized to execute this Agreement on behalf of the named party and that the information provided in this form is true, accurate and complete to the best of their knowledge. The undersigned further authorizes Service Provider to use the business information provided solely for the performance of services described herein and for billing and regulatory compliance purposes as required by law.

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