Client Consent and Acknowledgment Request

Client Consent and Acknowledgment Request

Parties and Effective Date

Client Name:

Client Address:

Service Provider Name:

Provider Address:

Effective Date:

Recitals

WHEREAS, the Client seeks to retain the Provider to perform the services described below and to authorize certain actions and disclosures necessary for the Provider to perform such services; and

WHEREAS, the Provider represents that it has the professional capacity and authority to perform the services and requires the Client's express consent to proceed, to receive information, and to undertake specified actions on the Client's behalf; and

WHEREAS, the parties intend that this Client Consent and Acknowledgment Request shall govern the Client's consents, acknowledgments, and the business terms under which the Provider will proceed.

Scope of Work

Payment Terms

Total Fee Amount:

Invoicing Terms:

Term and Termination

Term Commencement Date:

Term Expiration Date:

Either party may terminate this Agreement for material breach by the other party, provided that the non-breaching party has given written notice and a reasonable opportunity to cure as specified above.

Confidentiality

Each party agrees to maintain in confidence all non-public information disclosed by the other party that is designated as confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure ("Confidential Information"). Confidential Information shall not include information that is (a) already known to the recipient without obligation of confidentiality, (b) becomes publicly known through no wrongful act of the recipient, (c) independently developed by the recipient, or (d) rightfully received from a third party without restriction.

The recipient shall use Confidential Information solely to perform its obligations under this Agreement and shall restrict disclosure to those employees, contractors, or agents who need access to perform such obligations and who are bound by confidentiality obligations at least as protective as those set forth herein.

Acknowledgments and Consents

The Client explicitly acknowledges and consents to the following as necessary for the Provider to perform the Scope of Work. The Client must check each item to indicate consent.

I authorize the Provider to commence the Scope of Work described above and to act on my behalf as reasonably necessary to perform those services.

I consent to the Provider's collection, use, and limited disclosure of Client information to third parties as necessary to provide services, subject to the Confidentiality provisions.

I consent to receive communications and to execute documents electronically where permitted by law.

If applicable, I consent to reasonable background checks and verifications necessary for the Provider to fulfill contractual obligations.

Representations and Warranties

Each party represents and warrants that it has full power and authority to enter into this Agreement and to perform its obligations hereunder. The Client represents that all information provided to the Provider is true and complete to the best of the Client's knowledge.

Governing Law and Dispute Resolution

This Agreement shall be governed by and construed in accordance with the laws of the state specified below, without regard to conflict of laws principles. The parties agree to attempt in good faith to resolve disputes through negotiation before initiating formal legal proceedings.

Governing State:

Limitation of Liability

Except for liability arising from gross negligence, willful misconduct, or breach of confidentiality, neither party shall be liable to the other for consequential, incidental, special, or punitive damages. The Provider's aggregate liability for direct damages shall be limited to the total fees paid by the Client under this Agreement.

Entire Agreement and Severability

This Agreement, including any exhibits or attachments, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior and contemporaneous agreements, representations, and understandings. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

Execution and Certification

By signing below, each party certifies that the person signing has the authority to bind the respective party, that the party has read and understands this Client Consent and Acknowledgment Request, and that the party consents to and accepts the terms set forth herein.

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