Client Information Consent Form

CLIENT INFORMATION CONSENT FORM

Parties and Client Contact Information

Recitals

WHEREAS, Client Name: (hereafter "Client") seeks to engage the services of Service Provider: (hereafter "Service Provider") for the provision of services described below;

WHEREAS, Client will provide personal and business information to Service Provider and desires to grant limited consent for collection, use, retention, and disclosure of such information consistent with the terms of this agreement; and

WHEREAS, the parties wish to document the scope, payment terms, confidentiality, and the consent of Client to the collection and use of Client Information as necessary for performance of services.

Scope of Work

Service Provider will perform the services described below for Client. Client authorizes the collection and use of Client Information solely for the performance of these services and as explicitly permitted in this form.

Consent to Collection, Use, and Disclosure

Client hereby authorizes Service Provider to collect, access, use, retain, and disclose Client Information as necessary to perform the Scope of Work. The categories of information to be collected may include:

Full legal name
Contact information (email, telephone, address)
Billing and payment information
Identification numbers (as required for verification)
Sensitive personal data (special category data) — explicit consent granted

Client confirms that any selection of Sensitive personal data above constitutes explicit authorization to process such data for the limited purposes described in the Scope of Work and that Service Provider will implement appropriate safeguards.

Payment Terms

Client agrees to compensate Service Provider in accordance with the following payment terms.

Late payments will incur a late fee as set forth below. Client acknowledges responsibility for all fees due under this Agreement.

Term and Termination

This Agreement commences on the Start Date and continues until the End Date unless earlier terminated as provided below.

Either party may terminate for material breach if the breach is not cured within the notice period above. Upon termination, Service Provider will cease use of Client Information and will return or securely destroy Client Information as provided in the Confidentiality clause.

Confidentiality and Data Handling

Service Provider shall treat all Client Information as confidential and shall not disclose such information except (a) as necessary to perform the Scope of Work, (b) with Client's express prior written consent, or (c) as compelled by law, provided Service Provider gives Client prompt notice to the extent permitted. Service Provider will implement reasonable administrative, technical, and physical safeguards to protect Client Information from unauthorized access, use or disclosure.

Client Acknowledgments and Consent

By signing below, Client acknowledges that Client has read and understood the terms of this Consent Form, that Client's consent is voluntary, and that Client may withdraw consent in writing subject to any lawful limitations or retention obligations. Withdrawal of consent will not affect processing that occurred prior to receipt of withdrawal and may limit Service Provider's ability to continue performing certain services.

Client acknowledges the Confidentiality and Data Handling provisions above.
Client consents to the collection and use of Client Information for the Scope of Work described herein.
Client consents to disclosure to third-party service providers when necessary for performance (subject to confidentiality safeguards).

Governing Law; Entire Agreement

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

This document, together with any attached schedules and statements of work, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, and communications, whether oral or written. Any modification or waiver must be in writing and signed by both parties.

Representations and Signatures

Each party represents and warrants that it has full power and authority to enter into this Agreement and that the signatory below is duly authorized to execute this Agreement on behalf of the party.

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