Client Re-Registration Form

CLIENT RE-REGISTRATION FORM

Client Name:   Client ID:

RECITALS

WHEREAS, Client Name: (hereafter "Client") is registered with Company Name: (hereafter "Company");

WHEREAS, Client seeks to re-register or update its registration record to reflect current organizational, contact, and payment information and to reconfirm governing terms for the provision of services by Company; and

WHEREAS, the parties intend that this Client Re-Registration Form, together with the agreement provisions set forth below, govern the parties' relationship with respect to the services described herein and supersede prior inconsistent registration data to the extent provided herein.

UPDATED CLIENT INFORMATION

Individual    Corporation    LLC    Partnership    Other:

SCOPE OF WORK

Describe the services, deliverables, or the nature of the relationship that the Client expects to maintain with Company. Include any limits, service levels, or exclusions relevant to this registration.

PAYMENT TERMS

Payment Amount (if applicable):

Late Payment: In the event amounts due are not paid within the specified payment period, Client shall pay interest on overdue amounts at the rate of per month, or a minimum late fee of , whichever is greater. Client is responsible for reasonable collection costs and attorneys' fees incurred in enforcing payment obligations.

TERM AND TERMINATION

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

Either party may terminate this registration or related services for convenience upon giving days' prior written notice. Either party may terminate immediately for material breach or misconduct that remains uncured for a period of thirty (30) days after written notice, or immediately for insolvency, fraud, or illegal conduct.

CONFIDENTIALITY

All non-public information exchanged in connection with this re-registration, including business, financial, technical and client-specific data, shall be treated as confidential by the receiving party. Confidential information shall not be disclosed to third parties except as required by law or with prior written consent. Confidentiality obligations shall survive termination of this registration for a period of three (3) years.

Acknowledgement: Client and Company each acknowledge and agree to be bound by the confidentiality obligations set forth herein.

GOVERNING LAW

This Form and any obligations arising hereunder shall be governed by and construed in accordance with the laws of the State of , without regard to conflict of laws principles. Venue for any dispute shall be in the state or federal courts located within that jurisdiction.

ENTIRE AGREEMENT

This Client Re-Registration Form, together with any referenced attachments or amendments signed by the parties, constitutes the entire agreement between Client and Company with respect to the subject matter hereof, and supersedes all prior oral and written communications, representations, or agreements. Any amendment must be in writing and signed by authorized representatives of both parties.

REPRESENTATIONS AND CERTIFICATIONS

By signing below, Client certifies that the information provided on this form is true, complete and accurate to the best of its knowledge, that the signatory is authorized to bind Client to the terms herein, and that Client will promptly notify Company in writing of any material change to the information provided.

Certification Acknowledgement: I certify the information above is correct and I am authorized to bind the Client.

DOCUMENTS PROVIDED / CHECKLIST

The Client confirms the following supporting documents have been submitted or will be submitted upon request:

Certificate of Good Standing

Articles of Incorporation / Organization

Government-issued ID for authorized signatory

Other:

NOTICES

All notices required or permitted under this Form shall be in writing and delivered to the addresses specified in this Form or to such other address as either party designates by written notice. Notice is effective upon receipt.

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