Business Proceeds Report

Business Proceeds Report

WHEREAS

WHEREAS, Report Prepared By: , a business entity responsible for preparing and submitting this Business Proceeds Report for the reporting period set forth below; and

WHEREAS, Recipient/Payor: is the party to whom proceeds were paid or otherwise attributable and will rely on the representations and certifications herein for accounting and tax reporting purposes.

WHEREAS, the parties desire to record the details of proceeds, adjustments, and related certifications in a manner that will support accurate financial reporting and establish the terms under which this report is delivered and relied upon.

Reporting Information

Scope of Work

Describe the types of transactions, services rendered, or assets sold that gave rise to the proceeds reported herein and the method used to calculate amounts:

Itemized Proceeds

Provide each transaction or receipt that produced proceeds. Amounts should be reported in the currency stated and rounded to two decimal places.

Summary Totals

Adjustments and Deductions

Describe any returns, chargebacks, reimbursements, or other adjustments that reduce reported proceeds. Attach supporting documentation where applicable.

Payment Terms

Payment Amount for reporting services, if any:

Payment Schedule:

Late Fee: on overdue balances, computed monthly and compounded as permitted by law.

Term and Termination

This Report covers the period identified above and is effective as of Start Date: and End Date: .

Either party may terminate further reporting obligations upon written notice to the other party delivered at least days prior to the effective date of termination. Termination does not relieve either party of obligations accrued prior to termination.

Confidentiality

The parties acknowledge that the information contained in this Report may include confidential business information. Each party agrees to keep confidential and not disclose the other's confidential information except (a) to its employees, agents, accountants or legal advisors who have a need to know and are bound by confidentiality obligations at least as protective as those herein; or (b) as required by law or valid subpoena, in which event the disclosing party shall provide prompt notice to the other party when permitted.

Governing Law

This Report and any dispute arising out of it shall be governed by and construed in accordance with the laws of the State of without regard to conflict of laws principles.

Entire Agreement

This document constitutes the entire Business Proceeds Report and agreement between the parties with respect to the subject matter hereof and supersedes all prior understandings, representations, or agreements, whether written or oral, relating to such subject matter. Any amendment must be in writing and signed by both parties.

Supporting Documents Checklist

Include copies of the following documents as applicable. Check each box to confirm attachment.

Invoices and receipts (sales documentation)

Contracts or settlement statements

Bank statements and payment records

Other supporting documentation:

Certification and Acknowledgment

By signing below, the undersigned certifies under penalty of perjury that the information and amounts reported in this Business Proceeds Report are true, complete and correct to the best of their knowledge and belief, that supporting documentation has been retained and is available upon request, and that the reporting party is authorized to submit this Report on behalf of the business named above.

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