Business Interests Form

Business Interests Form

Disclosing Party Name:    Receiving Party Name:

Recitals

WHEREAS, the Disclosing Party has certain ownership interests, roles, investments or other business relationships with third-party entities that may be relevant to the Receiving Party’s assessment of conflicts of interest or engagement terms; and

WHEREAS, the Receiving Party requires a written disclosure of such business interests in order to evaluate and manage potential conflicts and to set forth agreed terms for services, compensation and confidentiality; and

WHEREAS, the parties desire to record the disclosed business interests and to set forth the scope of engagement, payment terms, confidentiality obligations and governing law as set forth in this Agreement.

Disclosure of Business Interests

The Disclosing Party certifies that the following represents all known business interests, positions and material financial relationships currently held by the Disclosing Party that could reasonably be expected to create a conflict with the engagement described below. If none, enter "None" in the first Business Name field.

Scope of Work

The parties agree that the Receiving Party will undertake the following services, advisory activities and due diligence in reliance on the disclosures above. Describe services, deliverables, milestones and responsibilities in detail.

Payment Terms

In consideration for the services described in the Scope of Work, the Receiving Party shall compensate the Disclosing Party as set forth below. All amounts are payable in lawful currency and are exclusive of taxes unless otherwise stated.

Late payments shall accrue interest and fees as specified below. If a different remedy is agreed, state it in Payment Schedule.

Term and Termination

This Agreement commences on the Start Date and, unless earlier terminated in accordance with this section, terminates on the End Date. Either party may terminate for material breach following written notice and the expiration of the notice period set forth below.

Confidentiality

The parties acknowledge that disclosures made under this form may include Confidential Information. Each party agrees to use Confidential Information solely for purposes of evaluating or performing the Scope of Work, to restrict disclosure to those employees or advisors with a need to know, and to employ commercially reasonable measures to protect such information. Confidential Information does not include information that is publicly known or rightfully received without confidentiality obligations.

The confidentiality obligations shall survive termination of this Agreement for a period of three (3) years unless a longer period is required by law or separate written agreement.

Acknowledgement of Confidentiality: I acknowledge and agree to the confidentiality terms above.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction specified below without regard to conflict of law rules. The parties submit to the exclusive jurisdiction of courts located within that jurisdiction for disputes arising under this Agreement.

Representations and Entire Agreement

Each party represents and warrants that it has full power and authority to enter into this Agreement and that the individual signing below is authorized to bind the signatory. The Disclosing Party represents that, to the best of its knowledge, the disclosures set forth in this form are true, complete and accurate as of the date of signing.

This Agreement constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior negotiations, understandings and agreements, whether written or oral, except as explicitly set forth in a separate written agreement signed by both parties.

Additional Provisions

Remedies: Remedies provided in this Agreement are cumulative and not exclusive. If any provision is held unenforceable, the remainder of the Agreement remains in effect. Amendments must be in writing and signed by both parties.

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