Client Agent Consent Form

CLIENT AGENT CONSENT FORM

Parties

Recitals

WHEREAS, Client Name: is the principal and desires to appoint and authorize an Agent to act on the Client's behalf for the matters described in this Consent Form; and

WHEREAS, Agent Name: has represented that the Agent is qualified and willing to perform such duties under the terms set forth herein.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

Scope of Authority

The Agent is specifically authorized to perform the following acts on behalf of the Client (check all that apply and describe scope fully above):

Negotiate and execute contracts consistent with approved terms
Access and obtain records or account information as necessary
Sign documents required to effectuate authorized transactions
Receive notices, disclosures, and communications on Client's behalf
Other (specify in Scope of Authority above)

Payment Terms

Compensation: Client agrees to pay Agent the sum of $ for services performed under this Consent Form, subject to the schedule below.

Late Payments: Any undisputed amount not paid within days after the applicable due date shall accrue a late fee of percent per month, or the maximum permitted by law, whichever is less.

Term and Termination

This Consent Form shall commence on and shall continue until unless earlier terminated as provided herein.

Either party may terminate this Consent Form without cause by providing written notice to the other party at least days prior to the intended termination date. Termination for cause may be effected immediately upon written notice for material breach, willful misconduct, or failure to cure a breach within a reasonable cure period of days after receipt of written notice.

Confidentiality

The Agent shall hold in strict confidence all non-public information and materials furnished by the Client or obtained by the Agent in the course of performing its duties under this Consent Form. The Agent shall not disclose such confidential information to any third party except (a) with the Client's prior written consent, (b) as reasonably required to perform the duties described herein, or (c) as required by law, provided that the Agent gives the Client prompt written notice of any compelled disclosure where permitted. Confidential information does not include information that is or becomes publicly available other than through breach of this provision, or is independently developed by the Agent without use of the Client's confidential information.

Representations and Warranties

Each party represents and warrants that it has the full right, power and authority to enter into this Consent Form and to perform its obligations hereunder. The Agent represents that the Agent will act in good faith and in the Client's best interest when exercising the authority granted in this Consent Form.

Governing Law

This Consent Form shall be governed by and construed in accordance with the laws of the State of without regard to conflict of laws principles.

Indemnification

The Agent shall indemnify and hold harmless the Client from and against all liabilities, losses, claims, damages and expenses (including reasonable attorney's fees) arising out of the Agent's willful misconduct, gross negligence, or material breach of this Consent Form. The Client shall indemnify and hold harmless the Agent from liabilities arising from the Client's misrepresentations or willful breach of obligations under this Consent Form.

Entire Agreement

This Consent Form, including any exhibits or attachments expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior and contemporaneous agreements, understandings and communications, whether written or oral. Any amendment or modification of this Consent Form must be in writing and signed by both parties.

Acknowledgment and Consent

By signing below, the Client acknowledges that the Client has read, understands, and consents to the grant of authority to the Agent as set forth in this Consent Form and that the Client may revoke this consent only in accordance with the Term and Termination provisions above. The Agent accepts the appointment and agrees to perform the duties described herein in accordance with applicable law and professional standards.

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