Business Name Form

BUSINESS NAME FORM

Date of Application:

RECITALS

WHEREAS, Applicant desires to adopt and register a business name under which Applicant will conduct commercial activities and to establish the legal and administrative terms governing the use of that name; and

WHEREAS, Registrant (the party receiving or recording the business name request) will record, administer, or otherwise certify the business name for the Applicant subject to payment of fees and compliance with the terms set forth herein; and

WHEREAS, the parties wish to reduce to writing their respective representations, fees, terms of registration, confidentiality obligations, and governing law applicable to the business name registration.

APPLICANT INFORMATION

BUSINESS NAME DETAILS

Jurisdiction(s) of Operation:

Effective Date of Name Use:    Intended Termination Date (if any):

SCOPE OF WORK

Describe the primary goods, services, and business activities to be conducted under the proposed business name. Provide sufficient detail to permit a review for potential name conflicts and classification.

PAYMENT TERMS

Registration Fee Amount:

Late Payment Fee: . Fees not timely paid may result in suspension or revocation of registration until cured.

TERM AND TERMINATION

Term Commencement Date:    Term Expiration Date:

Either party may terminate this registration and agreement for convenience by delivering written notice to the other party not less than days prior to the intended termination date. Registrant may immediately suspend or revoke registration for material breach, fraud, or trademark infringement after written notice and a reasonable cure period where appropriate.

CONFIDENTIALITY

Each party shall treat as confidential all non-public information disclosed by the other party in connection with this registration and shall not disclose such information to third parties except as required by law or with the prior written consent of the disclosing party. Confidential information excludes information that is or becomes publicly known through no fault of the receiving party.

GOVERNING LAW

This form and any agreement formed by its acceptance 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 document, together with any schedules, attachments, and fee receipts, constitutes the entire agreement between the parties concerning the registration and use of the business name and supersedes all prior negotiations and understandings. No amendment is effective unless in writing and signed by both parties.

CERTIFICATIONS AND REPRESENTATIONS

By submitting this Business Name Form, Applicant certifies under penalty of perjury that the information provided is true and correct, that Applicant has the right to use the proposed business name, that use of the proposed business name does not knowingly infringe upon the trademark or trade name rights of any third party, and that Applicant will comply with all applicable statutes and local ordinances governing the conduct of the described activities.

Applicant acknowledges and agrees that Registrant's recording or certification of the business name is an administrative act and does not create rights superior to any third party holding prior rights in the name. Applicant shall indemnify Registrant against any claims arising from Applicant's use of the name.

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