Client Package Request Form

CLIENT PACKAGE REQUEST FORM

Client Name:

Provider Name:

WHEREAS

WHEREAS, Client desires to request a package of services and deliverables from Provider as described in this Client Package Request Form and Provider is willing to provide such services subject to the terms and conditions set forth herein; and

WHEREAS, the parties intend for this document to memorialize the requested package, the scope of work, payment terms, delivery expectations, and other obligations of the parties with respect to the requested package.

CLIENT INFORMATION

PROVIDER INFORMATION

PACKAGE SELECTION

Select requested package(s) and specify quantity and unit amount where applicable.

Basic Package — description: preliminary consultation and standard deliverables. Quantity: Unit Price: $

Standard Package — description: expanded deliverables and revisions. Quantity: Unit Price: $

Premium Package — description: priority service, full deliverables, and premium support. Quantity: Unit Price: $

SCOPE OF WORK

The Provider shall perform the services and deliver the deliverables described below in accordance with the specifications agreed by the parties. The description below shall control over any inconsistent description in any accompanying communications unless amended in writing and signed by both parties.

PAYMENT TERMS

Total Estimated Amount: $

Unless otherwise stated, invoices are due within days of invoice date. Late payments will incur a late fee of % per month on outstanding balances or the maximum amount permitted by law, whichever is less.

DELIVERY & TIMING

Requested Delivery Date:

Delivery Method: Electronic Courier Client pickup

TERM AND TERMINATION

Term Commencement Date:    Term Expiration Date:

Either party may terminate this Request Form for convenience upon written notice to the other party delivered at least days prior to the intended termination date. Termination shall not relieve Client of payment obligations for services rendered and deliverables completed prior to termination.

CONFIDENTIALITY

Each party (Receiving Party) agrees that Confidential Information received from the other party (Disclosing Party) will be used solely for the purposes of fulfilling obligations under this Request Form and will not be disclosed to third parties except to employees, contractors, or advisors who have a need to know and who are bound by confidentiality obligations at least as protective as those herein. "Confidential Information" means non-public business, technical, financial and other proprietary information disclosed in any form. Confidential obligations shall not apply to information that is: (a) rightfully in the Receiving Party's possession without restriction prior to disclosure; (b) or becomes public through no fault of the Receiving Party; (c) lawfully received from a third party without restriction; or (d) independently developed. The obligations under this section shall continue for a period of years following termination or expiration of this Request Form, unless a longer period is required by applicable law.

GOVERNING LAW

This Request Form shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of law principles. Any dispute arising under this Request Form shall be subject to the exclusive jurisdiction of the state and federal courts located within that State.

ENTIRE AGREEMENT

This Client Package Request Form, together with any attachments or exhibits signed by the parties, 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. Any amendment or modification must be in writing and signed by authorized representatives of both parties.

ACKNOWLEDGMENT

By signing below, Client confirms that the information contained in this Request Form is accurate, that Client authorizes Provider to proceed in accordance with the Scope of Work and Payment Terms set forth herein, and that Client accepts the terms and conditions of this Request Form.

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