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Business Written Statement

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BUSINESS WRITTEN STATEMENT

Statement Title:

Statement Date:

Parties

Recitals

WHEREAS, Declarant is engaged in the business described above and possesses knowledge, records and factual information relevant to the matter described in this Statement; and

WHEREAS, Recipient has requested a written statement from Declarant for use in business, contractual, or regulatory matters and Declarant is willing to provide this written statement under the terms and conditions set forth herein; and

WHEREAS, the parties desire to record and certify certain facts, representations, and terms in a binding written statement.

Scope of Work / Purpose of Statement

Statement of Facts

Declarant hereby states, represents, and certifies the following facts are true and accurate to the best of Declarant's knowledge, information and belief:

Attached documents listed below (provide brief description)

Payment Terms

In consideration for the preparation, delivery and certification of this written statement, Recipient shall pay Declarant the fees set forth below and in accordance with this clause.

If payment is not made when due, interest shall accrue at the rate specified above from the due date until paid in full. Recipient shall also reimburse Declarant for reasonable costs of collection, including attorneys' fees, if applicable.

Term and Termination

This Statement shall commence on Start Date: and shall continue until End Date: unless earlier terminated as provided herein.

Either party may terminate this Statement for material breach if the breaching party fails to cure such breach within the notice period specified above. Termination shall not relieve Recipient of its obligation to pay for work performed and costs incurred prior to termination.

Confidentiality

Declarant and Recipient acknowledge that in the course of performance they may receive Confidential Information. "Confidential Information" means non-public business information, trade secrets, financial data, client lists, and other information reasonably considered confidential. Each party shall:

(a) hold Confidential Information in strict confidence and not disclose it to third parties except as required by law; (b) use Confidential Information solely to perform its obligations under this Statement; and (c) take reasonable measures to protect Confidential Information from unauthorized disclosure. The obligations in this paragraph shall continue for Confidentiality Period: following the termination or expiration of this Statement, unless a longer period is required by law.

Representations and Warranties

Each party represents and warrants that it has full power and authority to enter into this Statement and to perform its obligations hereunder; that the person signing below is authorized to bind the party; and that the information provided in this Statement and any attachments is true, accurate, and complete to the best of the signing party's knowledge.

Governing Law

This Statement shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of laws principles. Any dispute arising under this Statement shall be resolved in the courts of that State, unless the parties agree in writing to alternative dispute resolution.

Entire Agreement

This Statement, including any attachments and schedules, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and communications, whether written or oral. Any amendment or modification of this Statement must be in writing and signed by authorized representatives of both parties.

Certification

I certify under penalty of perjury that the information contained in this Business Written Statement and its attachments is true and correct to the best of my knowledge, and that I am authorized to execute this statement on behalf of the named Declarant.

Declarant Printed Name:

By:

Date:

Recipient Printed Name:

By:

Date:

Enter text✕

What a Business Written Statement Is and When It’s Used

A Business Written Statement is a formal, signed document that records a company’s factual account, position, or declaration for internal records, regulatory filings, contract disputes, vendor or client communications, or legal proceedings. It typically names the business, identifies the author or authorized signatory, summarizes the events or facts in chronological order, and attaches supporting exhibits. The statement should be clear, factual, dated, and signed; it may be notarized where required by statute or contract. Properly prepared statements support audits, investigations, claims processes, and contractual compliance.

Why a Clear Business Written Statement Matters

A concise written statement creates a durable record of the business position and evidence for audits, disputes, or regulatory review, and supports reliable decision making across teams and external stakeholders.

Why a Clear Business Written Statement Matters

Who Typically Prepares or Signs These Statements

Identify the authorized signatory in advance and confirm internal signature authority to avoid invalid signatures or later challenges.

  • General counsel and legal teams preparing statements for litigation or regulatory submissions.
  • Compliance officers and risk managers documenting incidents, investigations, or remediation steps.
  • Operations, finance, or contract owners providing factual summaries for vendors, insurers, or auditors.

Core Components of a Professional Business Written Statement

A standard statement follows a predictable structure so readers can verify facts quickly and locate supporting materials without ambiguity.

Heading

Document title, business name, contact details, and an internal reference or file number so the statement can be cross-referenced to case files and templates.

Author Identification

Full legal name, job title, business entity name, and business address of the person preparing the statement; state the author’s relationship to the matter.

Date and Effective Period

Clear effective or incident dates in MM/DD/YYYY format and a statement of the period the facts cover to limit ambiguity for deadlines and statutes of limitations.

Factual Narrative

A chronological, numbered account limited to observable facts and actions taken; avoid speculation or legal conclusions unless the author is legal counsel.

Supporting Exhibits

List and attach exhibits (emails, invoices, contracts, photos) with exhibit labels and descriptions so the record is self-contained.

Signature Block

Signature, printed name, title, date, and notary or witness details where required; include signer contact information for verification.

Required Information and Short Reference

Business Name: Exact legal entity name
Author Name: Full name and title
Event Dates: MM/DD/YYYY format
Exhibit List: Exhibit number and brief description
Signature: Handwritten or electronic signature
Authentication: Notary or witness details if required

Step-by-Step: Preparing and Signing the Statement

Follow these sequential steps to create a clear, verifiable Business Written Statement that can be relied on by internal reviewers or third parties.

  • 01
    Draft the facts: Write a concise, chronological narrative limited to verified observations.
  • 02
    Attach evidence: Number and attach all supporting documents as exhibits.
  • 03
    Confirm authority: Verify the signer has corporate authority to represent the business.
  • 04
    Sign and authenticate: Sign, date, and notarize or witness as required by law or contract.

Customizing the Statement Workflow for Digital Completion

Configure fields, routing, and authentication to match your internal approval and legal requirements before sending for signature.

Field Configuration
Signature Field Type Specify eSignature or wet signature
Authentication Level Email, SMS code, or advanced KBA
Routing Sequence Set signer order and conditional routing
Retention Settings Enable secure storage and audit trail

Typical Digital Signing Flow

This common workflow shows how a Business Written Statement moves from draft to a signed, auditable record when executed electronically.

  • Upload Document: Sender uploads the statement and attachments.
  • Place Fields: Add signature, date, and exhibit fields.
  • Select Signers: Enter signer emails and set authentication.
  • Complete & Archive: Recipient signs and system stores audit trail.

Technical and Integration Considerations for eSubmission

Confirm compatibility with existing systems (for example, Salesforce, NetSuite, Microsoft 365, or Google Workspace) and set retention and encryption policies to protect records.

  • Authentication: Email, SMS, or KBA methods
  • File Formats: PDF and DOCX supported
  • Integrations: CRM and storage connectors

Timing and Processing Expectations

Understand deadlines that can affect evidentiary value, statutory obligations, and internal reporting requirements when preparing a written statement.

Immediate Preservation:

Preserve digital and paper evidence as soon as the incident is known.

Internal Reporting:

Meet corporate reporting windows set by policy or contract.

Regulatory Filings:

File or attach statements to regulatory submissions by the regulator’s deadlines.

Retention Start Date:

Retention typically starts on the statement creation date.

Audit Availability:

Ensure signed records are retrievable for audits per retention policy.

Common Risks and Consequences of an Incorrect Statement

Contractual Breach: May trigger damages or termination
Regulatory Penalty: Fines or enforcement action
Evidentiary Exclusion: Courts may reject unreliable statements
Tax Implications: Incorrect facts can affect filings
Reputational Harm: Public disclosure can damage trust
Operational Delay: Investigations and remediation costs

Illustrative Use Cases from Real Organizations

These examples show how businesses use written statements to close gaps in records, support claims, or streamline remote approvals.

Martin Properties — Real Estate

Property closing summary prepared by the broker to document tenant representations and inspection results.

  • “I can process and execute all of these documents online with 100% compliance and built-in security.”
  • The signed statement and attached exhibits were used to resolve a post-closing dispute and provide evidence to the title insurer, reducing the need for serial correspondence and clarifying liability.

Fertility Centers of Illinois — Healthcare

Clinical administrative statement documenting patient consent and appointment chronology.

  • “The airSlate SignNow team has been exceptional, responsive, the API has been great.”
  • The written statement, combined with the consent exhibit, supported an internal quality review and met retention and privacy requirements under HIPAA while preserving a clear audit trail.

eSignature Vendor Comparison for Executing Business Written Statements

Comparing common vendor attributes helps match your authentication, compliance, and cost requirements when converting written statements into signed, auditable records.

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 Varies by vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently Asked Questions About Business Written Statements

Answers to common issues encountered when drafting, authenticating, or submitting a Business Written Statement.


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