Client Agent Info Sheet

Client Agent Info Sheet and Agency Agreement

Client Name:    Agent Name:

Client Address:

Agent Business Address:

RECITALS

WHEREAS, Client engages Agent to perform agent services described in this agreement and to collect and provide Client-specific information necessary to perform such services; and

WHEREAS, Agent represents that it possesses the requisite experience, personnel, and authority to render the services set forth and will act consistently with Client's written instructions and applicable law; and

WHEREAS, the parties desire to record essential contact, billing, regulatory and authorization details and to set forth the terms that will govern the provision of services.

AGENT CONTACT INFORMATION

Individual Corporation LLC Partnership Other:

CLIENT INFORMATION

SCOPE OF WORK

The Agent will perform the services described below on behalf of Client. The Agent's duties shall be performed in accordance with Client's written instructions and industry standards.

COMPENSATION AND PAYMENT TERMS

Payment Amount:    Billing Frequency:

Late Payment Fee: If any undisputed payment is not received within days of the invoice due date, interest will accrue at % per month (or the maximum lawful rate, if lower). The parties agree that invoiced disputes properly raised in writing will suspend interest accrual on the disputed portion until resolution.

TERM AND TERMINATION

Term Start Date:    Term End Date:

Either party may terminate this Agreement for convenience upon days' prior written notice. Either party may terminate immediately for material breach that remains uncured after days' written notice specifying the breach. Termination does not relieve Client of obligations to pay for services performed through the effective date of termination and for any non‑cancellable obligations incurred by Agent on Client's behalf.

CONFIDENTIALITY

"Confidential Information" means nonpublic information disclosed by one party to the other that is designated confidential or that a reasonable person would understand to be confidential. The receiving party will (a) use Confidential Information solely to perform obligations under this Agreement, (b) limit access to employees and contractors with a need to know, and (c) protect Confidential Information with at least the same degree of care used to protect its own confidential information. Confidential Information does not include information that is or becomes publicly available through no breach by the receiving party, that is independently developed without reference to the disclosing party's Confidential Information, or that is rightfully obtained from a third party without confidentiality obligations. These obligations survive termination for a period of three (3) years, except that trade secrets will be protected for as long as they remain trade secrets.

COMPLIANCE; REPRESENTATIONS

Each party represents and warrants that it has the authority to enter into this Agreement and that its performance will comply with applicable laws and regulations. Agent will not take any action on behalf of Client that would knowingly violate law or subject Client to regulatory or civil liability without Client's prior written consent.

GOVERNING LAW; DISPUTE RESOLUTION

This Agreement will be governed by and construed in accordance with the laws of the state of without regard to conflicts of law principles. The parties submit to the exclusive jurisdiction of the state and federal courts located in that state for any dispute arising out of or relating to this Agreement.

ENTIRE AGREEMENT

This document, together with any attachments or written amendments signed by both parties, constitutes the entire agreement between Client and Agent concerning the subject matter herein and supersedes all prior or contemporaneous oral or written agreements. No modification of this Agreement will be effective unless in writing and signed by authorized representatives of both parties.

ADDITIONAL ACKNOWLEDGMENTS

Client expressly authorizes Agent to act as Client's agent to the extent necessary to perform the scope of work described above. Client acknowledges responsibility for the accuracy of information provided to Agent and agrees to promptly notify Agent in the event of any material change to such information.

Agent represents that, to the best of its knowledge, no conflict of interest exists with respect to the services to be performed.
A potential conflict has been disclosed in writing to Client and accepted in writing by Client. If checked, explain below:

NOTICES

All notices under this Agreement must be in writing and delivered to the addresses set out above or to such other address as a party designates in writing. Notice is effective on personal delivery, delivery by certified mail, or confirmed overnight courier.

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