Business Questionnaire

Business Questionnaire

Recitals

WHEREAS, Client Name: (the "Client") seeks information and representations from the Respondent for evaluation of potential business services; and

WHEREAS, Respondent Name: (the "Respondent") will provide the information requested herein and acknowledges that such information will be relied upon by the Client in assessing engagement and contracting decisions.

WHEREAS, the parties intend that the information provided in this Business Questionnaire will form part of the governing documentation between the parties and may be incorporated into a separate agreement.

Company Information

Corporation LLC Partnership Sole Proprietor Other:

Business Operations & Questionnaire

Do you have existing contracts that could affect performance? Yes No

General Liability Professional Liability Workers' Compensation Other

Has the company or any principal been subject to litigation, regulatory enforcement, or administrative proceedings in the past five (5) years? Yes No

Scope of Work (If engaged)

The parties acknowledge that any engagement will be accompanied by a Scope of Work setting forth deliverables, milestones, and acceptance criteria. Provide anticipated scope details below.

Payment Terms

Standard payment terms, unless otherwise agreed in writing, shall be set forth as follows.

Late payments shall accrue interest at per month (or the maximum allowed by applicable law), plus recovery of collection costs and reasonable attorneys' fees.

Term and Termination

The anticipated term of any engagement will commence on Start Date: and continue until End Date: unless earlier terminated in accordance with this provision.

Either party may terminate for convenience upon written notice delivered not less than prior to the effective termination date. Termination for cause may be effected immediately upon written notice for material breach that remains uncured after a reasonable cure period.

Confidentiality

The Respondent acknowledges that Client confidential information disclosed in connection with an evaluation or engagement is proprietary. The Respondent shall keep such Confidential Information in strict confidence, shall not use it except in furtherance of the mutually agreed business purpose, and shall not disclose it to any third party except as required by law or with the Client's prior written consent. Reasonable measures shall be taken to protect such Confidential Information at least as stringent as those used to protect Respondent's own confidential information.

Acknowledgement: By checking this box the Respondent certifies that it agrees to the confidentiality obligations set forth above.

Governing Law; Entire Agreement

This Questionnaire, and any subsequent agreement incorporating it, shall be governed by and construed in accordance with the laws of the State of , without regard to conflict of law principles.

The parties agree that this document, together with any executed engagement terms, constitutes the entire understanding between the parties with respect to the subject matter hereof and supersedes all prior discussions, proposals, or agreements, whether written or oral.

Certifications and Representations

The Respondent certifies that the information provided in this Business Questionnaire is true, complete, and correct to the best of its knowledge as of the date of signature. The Respondent understands that material misrepresentations may be considered a breach and may disqualify Respondent from consideration or result in termination of any engagement.

Certification: I certify the foregoing.

References

Provide up to three professional references.

Additional Information

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