Client E-Consent Form

CLIENT E-CONSENT FORM

This Electronic Consent and Service Agreement (the "Agreement") is entered into by and between:

Client Name:    Client Address:

Provider Name:    Provider Contact:

WHEREAS

WHEREAS, Provider is engaged in the business of providing professional services as described below and uses electronic communications and records in the ordinary course of business; and

WHEREAS, Client desires to receive communications, authorizations, disclosures and to execute documents electronically in connection with Provider's services and agrees to the terms and conditions set forth in this Agreement; and

WHEREAS, the parties intend for electronic records and signatures to have the same legal effect as original handwritten signatures and paper records to the fullest extent permitted by applicable law.

SCOPE OF WORK

PAYMENT TERMS

If any payment is more than days late, Provider may assess a late fee equal to of the overdue amount and/or interest at the maximum rate permitted by law.

TERM AND TERMINATION

Term Commencement Date:    Term End Date (if applicable):

Either party may terminate this Agreement for convenience upon days' prior written notice to the other party. Provider may terminate immediately for cause if Client materially breaches payment or confidentiality obligations and fails to cure within a commercially reasonable period following notice.

CONFIDENTIALITY

Each party shall treat as confidential all nonpublic 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 or becomes publicly available without breach of this Agreement, is rightfully received from a third party without restriction, or is independently developed without use of the other party's Confidential Information.

The receiving party will use at least the same degree of care to protect Confidential Information as it uses to protect its own confidential information but in no event less than reasonable care. Disclosure is permitted to the extent required by law, regulation or valid court order, provided the disclosing party provides prompt notice to the other party when legally permissible.

ELECTRONIC CONSENT AND COMMUNICATIONS

By selecting the boxes below and signing this Agreement electronically, Client expressly consents to the use of electronic records and electronic signatures to conduct transactions with Provider. Client acknowledges that electronic records and signatures carry the same legal effect as paper records and handwritten signatures to the extent permitted by applicable law.

  I consent to receive disclosures, notices, invoices and other records electronically and agree that such records satisfy any legal requirement for written notice.

  I consent to the use of electronic signatures for execution of this Agreement and related documents.

  I consent to receive communications, appointment reminders, invoices and transactional notices via electronic means including email, SMS, or secure messaging as selected by Provider.

Client acknowledges that to access and retain electronic records Client must have a device capable of accessing email and electronic documents, a compatible current web browser or app, and the capacity to view, download and print documents if desired. Provider is not responsible for Client's inability to access electronic records due to Client's hardware, software, or connectivity.

WITHDRAWAL OF CONSENT

Client may withdraw consent to electronic communications at any time by providing written notice to Provider at the contact information provided above. Withdrawal of consent will not affect the legal validity or enforceability of records created or disclosures made prior to withdrawal. Following withdrawal, Provider may require that Client receive records in paper form and may charge reasonable fees for reproduction and delivery of paper copies in accordance with applicable law.

GOVERNING LAW

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

ENTIRE AGREEMENT

This Agreement, together with any attachments and electronically executed documents, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, negotiations and communications, whether oral or written. No amendment or modification shall be binding unless in writing and signed by both parties (electronic signatures accepted).

ACKNOWLEDGMENTS

Client represents and warrants that Client has the authority to enter into this Agreement, has read and understands the terms, and agrees that typing Client's name below and submitting this form constitutes Client's electronic signature for all purposes under this Agreement.

Initials (Client):

Sign Now