Client Account Update Form

CLIENT ACCOUNT UPDATE FORM

RECITALS

WHEREAS, Client Name: (the "Client") maintains an account with Account Number: with Service Provider: .

WHEREAS, the Client requests updates to its account records and related service preferences and the Service Provider is willing to process such updates under the terms contained in this document, effective as of Effective Date: .

SCOPE OF WORK

The Service Provider will perform the following account update activities as requested by the Client. The updates may include verification of identity, modification of contact and billing information, addition or removal of authorized users, and configuration of account preferences. The Service Provider will record changes in Provider systems and notify Client of completion in accordance with the schedule below.

CLIENT INFORMATION

UPDATES REQUESTED

Select all items to be updated:

Update address on file

Update primary contact information

Update billing information

Add or remove authorized users

Change payment method

AUTHORIZED CONTACTS

List individuals authorized to request account changes:

PAYMENT TERMS

If any fees apply to processing requested updates, the parties agree to the following terms.

TERM AND TERMINATION

This Account Update Agreement commences on Start Date: and continues until End Date: , unless earlier terminated as provided below.

Either party may terminate this Agreement for convenience upon Notice Period (days): days' written notice. Immediate termination may occur for material breach, fraud, or unauthorized access to account data. Upon termination, the Service Provider will cease processing further updates and will return or destroy Client confidential information as required by this Agreement.

CONFIDENTIALITY

Each party acknowledges that during performance of this Agreement it may receive confidential or proprietary information of the other party. The receiving party will (a) use such information solely for the purposes of processing the requested account updates, (b) restrict disclosure to employees and contractors who have a need to know and are bound by confidentiality obligations at least as protective as those herein, and (c) implement reasonable administrative, physical, and technical safeguards to protect such information. Confidential information does not include information that is publicly known through no fault of the receiving party, rightfully received from a third party without restriction, or independently developed by the receiving party without use of the disclosing party's confidential information.

GOVERNING LAW

This Agreement will be governed by and construed in accordance with the laws of the jurisdiction chosen by the parties below. The parties consent to the exclusive jurisdiction and venue of the courts located in that jurisdiction for resolution of disputes arising under this Agreement.

ENTIRE AGREEMENT

This document, together with any written attachments or amendments signed by both parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous oral and written agreements, proposals, and communications relating thereto. No modification of this Agreement will be effective unless in writing and signed by authorized representatives of both parties.

CERTIFICATION AND AUTHORIZATION

By signing below, the undersigned certify that they are authorized representatives of their respective parties, that the information provided in this form is true and accurate to the best of their knowledge, and authorize the Service Provider to make the requested updates to the Client account in accordance with this Agreement.

I certify that I am an authorized representative and that the information provided is accurate.

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