Client Qualification Questionnaire

Client Qualification Questionnaire

WHEREAS

WHEREAS, the Company seeks to evaluate the Client's suitability and capability to enter into a commercial engagement for the provision of services identified in the Scope of Work; and

WHEREAS, the Client agrees to provide accurate information and authorizations necessary for the Company to assess creditworthiness, operational capacity, and regulatory compliance before entering into a binding agreement;

NOW, THEREFORE, the parties provide the following information under penalty of perjury to support qualification and contract formation.

Client Information

Business Profile

Legal Entity Type: Sole Proprietor Partnership Corporation LLC Other:

Services Requested / Scope of Work

Provide a clear description of the services or deliverables the Client requests. Include measurable objectives, milestones, and any critical deadlines.

Financial Information

Authorization: Client authorizes the Company to obtain credit reports and trade references for the purpose of qualification and underwriting.

Compliance & Risk Assessment

Please indicate the following by checking Yes or No, and provide brief explanations where applicable.

Ongoing litigation or material claims: Yes No
If yes, provide summary:

Bankruptcy within last 7 years: Yes No
If yes, provide date and court:

Regulatory or licensing issues that would affect performance: Yes No
If yes, explain:

Attachments Checklist

Please indicate attached documents: Most recent financial statements (audited or reviewed) Business plan or project overview Trade or credit references Identification for authorized signatory Other (describe):

Payment Terms

Proposed payment structure and obligations. Complete the following fields to define compensation and schedule.

Term and Termination

Commencement and expiration dates, and termination rights.

Start Date:    End Date:

Confidentiality

The Client and the Company acknowledge that during evaluation and any subsequent engagement, each may disclose Confidential Information. Confidential Information means non-public business, technical or financial information disclosed in writing, orally, or by inspection of tangible objects. Each party agrees: (a) to use Confidential Information solely for purposes of evaluation and performance of the agreement; (b) to restrict disclosure to employees, agents, or subcontractors on a need-to-know basis who are bound by confidentiality obligations no less protective than those herein; (c) to exercise reasonable care to protect such information; and (d) to return or destroy Confidential Information upon written request or termination. Confidentiality obligations shall survive termination for a period of three (3) years except for trade secrets, which shall remain protected for as long as they qualify as trade secrets under applicable law.

Governing Law

This Questionnaire and any resulting contractual relationship shall be governed by and construed in accordance with the laws of the jurisdiction selected by the parties below, without regard to conflict of laws principles. Parties submit to the exclusive jurisdiction of the courts in the selected jurisdiction.

Entire Agreement

This Questionnaire, together with any attachments and subsequent written agreements executed by the parties, constitutes the entire understanding between the parties with respect to the subject matter and supersedes all prior discussions, representations, or agreements, whether written or oral. Any modification must be in writing and signed by authorized representatives of both parties.

Certifications and Authorizations

By signing below, the undersigned certifies that the information provided in this Questionnaire is true, complete and accurate to the best of their knowledge, that they are authorized to provide such information on behalf of the Client, and that the Client consents to the Company conducting credit, background and reference checks as necessary to evaluate qualification.

Authorization to Obtain and Share Information: I authorize the Company and its agents to obtain and share credit, financial and reference information for evaluation purposes.

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