Who should sign the form?

Authorized representatives with delegated signature authority must sign. Typical signatories include the department head, finance controller, or authorized officer. If legal or compliance approval is required, include their signature line and retain delegation records.

Is notarization required?

Not typically required for internal exclusions, but state law or contract terms can mandate notarization. For exclusions affecting real property or third-party filings, obtain a notarized acknowledgment or consider remote online notarization to satisfy statute-based requirements.

Can this be signed electronically?

Yes. Electronic signatures meet legal requirements under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the signature demonstrates intent, consent, attribution, and retention capability. Confirm any industry-specific exceptions before relying solely on eSignature.

What supporting documents are required?

Attach contracts, exhibits, serial or account identifiers, legal opinions, and approvals or memos. For tax-impacting exclusions, include counsel or accounting analyses and any communications with taxing authorities to substantiate the position.

How do I correct a mistake?

Do not alter signed originals. Prepare a corrective amendment that references the original form, details the correction, and is signed by the same authorized parties. Preserve both documents and an audit log showing the change.

How long must records be kept?

Retain the exclusion and supporting records per applicable standards: tax records at least three years (IRC §6501(a)), HIPAA six years if PHI applies (45 CFR §164.530(j)), and longer if state law requires. Consult counsel for specifics.

Electronic Signature
Templates
Miscellaneous
Business Use Exclusion Form

Business Use Exclusion Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

BUSINESS USE EXCLUSION FORM

This Business Use Exclusion Form (the Agreement) is made effective as of by and between Excluding Party: and Recipient Party: .

RECITALS

WHEREAS, Excluding Party operates certain assets, services or facilities that have been classified for business use purposes and desires to exclude specified uses or assets from such classification under the terms of this Agreement;

WHEREAS, Recipient Party is willing to acknowledge and record the exclusion described herein and to accept any related conditions, limitations and certifications set forth in this Agreement;

WHEREAS, the parties intend by this Agreement to set forth the scope, payment terms (if any), and legal protections governing the requested business use exclusion.

PARTIES & CONTACT INFORMATION

Excluding Party — Legal Name Excluding Party — Address Recipient Party — Legal Name Recipient Party — Address

SCOPE OF WORK

Describe the services, assets, locations or transactions to be excluded from business use classification and the precise boundaries of the exclusion. Include identifying details such as asset identifiers, addresses, account numbers, or other specific descriptors.

EXCLUSION DETAILS

Specific exclusions requested (be explicit). If partial exclusions apply, describe metrics or allocation methods used to determine the excluded portion.

PAYMENT TERMS

In consideration for the Recipient Party's acceptance and administrative processing of this exclusion, the parties set forth the payment terms below. If no payment is required, enter "None".

Payment Amount Payment Schedule / Due Date Late Fee / Interest

TERM AND TERMINATION

The exclusion set forth in this Agreement shall commence on and shall terminate on , unless earlier terminated in accordance with the terms below.

Either party may terminate this Agreement for cause upon written notice to the other party with a notice period of days, stating the grounds for termination and allowing a reasonable cure period where applicable.

CONFIDENTIALITY

Each party shall maintain as confidential all non-public information received in connection with this Agreement and shall not disclose such information except as required by law or with the prior written consent of the disclosing party. Obligations of confidentiality shall survive termination of this Agreement for a period of three (3) years.

By checking the box below, the undersigned acknowledges the confidential nature of information exchanged in connection with this exclusion and agrees to be bound by the confidentiality obligations set forth above.

I acknowledge and agree to confidentiality obligations

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to rules governing conflicts of law.

ENTIRE AGREEMENT

This Agreement, together with any attachments or written amendments executed by both parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings and negotiations, whether written or oral.

CERTIFICATIONS

The undersigned certify that they are authorized to request or accept the exclusion described herein. The undersigned further certify that the information provided in this form is true, accurate and complete to the best of their knowledge, and understand that materially false statements may constitute breach of this Agreement and may subject the signer to remedies provided herein and available at law or equity.

I certify that the information provided is true, accurate and complete

Excluding Party — Printed Name:

By:

Date:

Recipient Party — Printed Name:

By:

Date:

What the Business Use Exclusion Form Covers

The Business Use Exclusion Form is a written declaration used by organizations to exclude certain transactions, assets, or accounts from routine business use classifications. It documents the specific activity or property excluded, identifies responsible parties, sets effective dates, and explains the legal or contractual basis for the exclusion. Employers, vendors, and administrators use it to limit liability exposure, clarify tax or compliance treatment, and record exceptions to standard policies. The form is used as an internal control and audit record and may accompany regulatory filings or third-party requests.

Why a Clear Exclusion Form Matters

Use this form to create a documented, auditable exclusion that clarifies treatment for tax, regulatory, or internal policy purposes. A clear exclusion reduces ambiguity, supports compliance reviews, and provides evidence for auditors or third parties who question standard business classifications.

Who Typically Prepares and Signs This Form

Typical users include finance, compliance, and operations teams who manage exceptions and document nonstandard business treatments.

Finance managers documenting asset classification exceptions for tax and internal reporting purposes.
Compliance officers recording deviations from standard controls and regulatory treatment.
Business unit leaders approving temporary operational exclusions during projects or transitions.

The form helps consolidate decision history and establish accountable signatories for any documented exclusion effectively.

Step-by-Step: Completing the Form

Follow these steps to complete the Business Use Exclusion Form accurately and ensure consistent internal records and auditability.

01

Prepare Details: Identify the excluded item and legal basis.
02

List Parties: Enter all responsible individuals and contact information.
03

Set Dates: Record effective and end dates using MM/DD/YYYY.
04

Sign & Store: Obtain authorized signatures and retain copies in a secure system.

Typical Online Workflow Settings

Configure an online workflow to route the form to reviewers, capture signatures, and preserve an audit trail.

Field	Configuration
Trigger	Send to finance and compliance automatically
Routing	Sequential: preparer → approver → legal
Authentication	Email link with access code or SSO
Storage	Save PDF to document management with audit log

Technical Considerations for eSubmission and Storage

Online completion and eSubmission require compatible file formats, authentication options, and integration with document storage or CRM systems.

Supported Formats: PDF, Word DOCX, HTML, Excel
Integrations: Salesforce, NetSuite, Microsoft 365
Authentication: Email link, SMS code, SSO

Workflow Sequence for Electronic Execution

The typical routing sequence ensures documented consent, secure signing, and persistent audit records for the exclusion.

Upload: Attach completed form and exhibits.
Place Fields: Add signature, date, and checkbox fields.
Authenticate: Use email link, SMS code, or SSO.
Archive: Save signed PDF and certificate of completion.

Timing Considerations and Review Intervals

Certain exclusions affect tax reporting and audits; note review intervals and any filing-related deadlines to ensure timely compliance.

Provide on Request:

No fixed filing deadline; deliver when requested by payer or auditor.

Effective Date:

Use MM/DD/YYYY; determines tax and compliance treatment.

Periodic Review:

Review exclusions annually or on material change.

Audit Retention:

Keep supporting records consistent with retention rules.

Tax Filings:

If exclusion affects tax return, update filings before deadline.

Common Preparation Pitfalls to Avoid

Vague descriptions that omit identifiers (serial numbers, account codes) increase audit risk; always include precise identifiers and attachments for clarity.
Missing or mismatched effective or end dates can create conflicting compliance positions and affect tax treatment or statute of limitations calculations.
Unsigned approvals or missing delegated authority documentation can invalidate exceptions and expose organizations to internal control findings.
Retaining only paper copies without indexed digital records impairs searchability and may fail modern electronic retention practices.

Consequences of Incomplete or Incorrect Forms

Tax Penalty: IRC §6721 penalties apply

Backup Withholding: 24% rate may be triggered

Audit Adjustment: Reclassification can increase tax liability

Contract Risk: Potential breach claims and damages

Regulatory Action: Compliance violations invite enforcement

Internal Control: Failed process increases remediation costs

Security and Compliance Considerations

Encryption: TLS 1.2/1.3 in transit, AES-256 at rest

Audit Trail: Tamper-evident logs with timestamps and IPs

HIPAA BAA: BAA available for protected health information

Authentication: Support for SSO, SMS codes, and KBA

Certifications: SOC 2 Type II, ISO 27001 compliance

Access Controls: Role-based permissions and audit logging

Comparing baseline eSignature pricing and capabilities

Compare baseline pricing and key capabilities across common eSignature vendors to assess costs and compliance fit for the Business Use Exclusion Form.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	No	No	Yes, limited	Yes, limited
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/year	No cap	No cap	No cap

Frequently Asked Questions About the Form

Answers to common questions about completing, signing, and storing the Business Use Exclusion Form accurately.

Need help? Contact support

Who should sign the form?
Authorized representatives with delegated signature authority must sign. Typical signatories include the department head, finance controller, or authorized officer. If legal or compliance approval is required, include their signature line and retain delegation records.
Is notarization required?
Not typically required for internal exclusions, but state law or contract terms can mandate notarization. For exclusions affecting real property or third-party filings, obtain a notarized acknowledgment or consider remote online notarization to satisfy statute-based requirements.
Can this be signed electronically?
Yes. Electronic signatures meet legal requirements under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted, provided the signature demonstrates intent, consent, attribution, and retention capability. Confirm any industry-specific exceptions before relying solely on eSignature.
What supporting documents are required?
Attach contracts, exhibits, serial or account identifiers, legal opinions, and approvals or memos. For tax-impacting exclusions, include counsel or accounting analyses and any communications with taxing authorities to substantiate the position.
How do I correct a mistake?
Do not alter signed originals. Prepare a corrective amendment that references the original form, details the correction, and is signed by the same authorized parties. Preserve both documents and an audit log showing the change.
How long must records be kept?
Retain the exclusion and supporting records per applicable standards: tax records at least three years (IRC §6501(a)), HIPAA six years if PHI applies (45 CFR §164.530(j)), and longer if state law requires. Consult counsel for specifics.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now