Business Start-Up Questionnaire

BUSINESS START-UP QUESTIONNAIRE AND ENGAGEMENT AGREEMENT

Client Name:   Service Provider Name:   Effective Date:

RECITALS

WHEREAS, Client intends to form or commence operations of a business enterprise and requires advisory, formation and related professional services from Service Provider; and

WHEREAS, Service Provider has the experience and capacity to provide business formation, organizational and advisory services, and Client desires to engage Service Provider under the terms set forth in this document; and

WHEREAS, the parties desire to record certain engagement terms and to collect information necessary for the commencement of services.

SCOPE OF WORK

Service Provider will perform the tasks described below and any other tasks expressly agreed in writing by both parties. Describe the requested services in sufficient detail to define deliverables, timing, and responsibilities.

BUSINESS INFORMATION

Phone:   Email:   Website:

ENTITY DETAILS

Select proposed entity type:

Sole Proprietorship   Partnership   LLC   Corporation   Nonprofit   Other:

OWNERS / PRINCIPALS

Provide up to three principal owners. Include full legal name, title, percentage ownership, and contact information.

Title:   Ownership %:   Contact:

Title:   Ownership %:   Contact:

Title:   Ownership %:   Contact:

FUNDING, BANKING, AND FINANCIALS

Bank account to be opened: Yes   Will a separate business credit card be requested? Yes

OPERATIONS & COMPLIANCE

Anticipated start of operations:   Fiscal year end month:

Estimated initial employees:   Will payroll be required at formation? Yes

INTELLECTUAL PROPERTY & CONTRACTS

Existing IP filings: Trademark pending   Patent pending   Copyrights   None

INSURANCE & RISK MANAGEMENT

Insurance anticipated: General liability   Professional liability   Workers' compensation   Property   Other

SERVICES REQUESTED

Please indicate services Client requests:

Entity formation and filings   Operating agreement / bylaws   Employment agreements / contractor agreements   Trademark / IP filings   Drafting commercial contracts

Accounting system setup   Bookkeeping   Tax registration (EIN, sales tax)   Other

ENGAGEMENT PAYMENT TERMS

Total fee for services:   Deposit required on engagement:

Late fee for overdue payments:   Accepted payment methods:

TERM AND TERMINATION

Term Commencement Date:   Anticipated completion or end date:

Either party may terminate this engagement for material breach that remains uncured for the notice period above. Upon termination, Client is responsible for all fees and expenses incurred through the effective date of termination and for any non-cancellable commitments.

CONFIDENTIALITY

Each party shall maintain in confidence all non-public information designated as confidential or that, under the circumstances, ought reasonably to be treated as confidential, and shall not disclose such information to third parties except as required by law. Confidential information does not include information that is or becomes publicly available other than by breach of this agreement, independently developed without use of the other party’s confidential information, or rightfully obtained from a third party without restriction.

Upon termination or upon written request, each party shall return or destroy the other party’s confidential materials and certify in writing the disposition of such materials.

GOVERNING LAW; ENTIRE AGREEMENT

Governing law:

This Questionnaire together with any written engagement terms and fee schedule attached hereto constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings, agreements and communications, whether written or oral. Any amendment must be in writing signed by both parties.

REPRESENTATIONS AND CERTIFICATION

Client represents and warrants that the information provided in this Questionnaire is true, complete and correct to the best of Client’s knowledge and belief, and that Client will promptly notify Service Provider in writing of any material change to such information. Client understands that Service Provider will rely on the information provided to prepare formation documents, agreements, registrations and related filings.

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