Client Removal Form

CLIENT REMOVAL FORM

Recitals

WHEREAS Client Name: (the "Client") is or was receiving services from Service Provider Name: (the "Provider"); and

WHEREAS the parties wish to document the removal of the Client from the Provider's active accounts, systems, or engagements and to set forth the obligations, timelines, and conditions applicable to such removal.

WHEREAS the parties intend that this form operate as a binding agreement governing the removal process, the return or destruction of materials, settlement of outstanding amounts, and any residual obligations.

Administrative Details

Request Date:     Effective Removal Date:

Scope of Work / Services to be Removed

Removal Actions and Property

Check all actions to be completed as part of removal:

Terminate electronic access — revoke all logins, API keys, and credentials under Client control.
Return physical property — return equipment, documents, or materials in Provider custody.
Secure deletion — delete or sanitize Client data from Provider systems in accordance with retention policies.
Transfer deliverables — handover of final deliverables and documentation to Client contact.

Payment Terms and Financial Settlement

Outstanding Balance Due: $

Late Payment Fee:

Term and Termination

Removal Effective Start Date:     Expected Completion Date:

Either party may terminate any further obligations under this removal process upon written notice of days to the other party, provided that obligations accrued prior to termination, including payment and the return of property, remain enforceable.

Confidentiality

Each party acknowledges that, in the course of the removal process, Confidential Information of the other party may be disclosed. Each party agrees to (a) continue to protect such Confidential Information using at least the same degree of care it uses to protect its own confidential information; (b) use Confidential Information solely for the purposes of effectuating this removal; and (c) not disclose Confidential Information to any third party except as required by law or as necessary to perform the obligations set forth in this form.

Acknowledgement of Confidentiality obligations: (check to confirm).

Representations & Warranties

Each party represents and warrants that it has full authority to enter into this Client Removal Form and that the person signing below is authorized to bind the respective party. The Client represents that all information provided in this form is true and complete to the best of its knowledge.

Governing Law; Entire Agreement

Governing Law: This Client Removal Form shall be governed by and construed in accordance with the laws of the state or jurisdiction selected by the Provider: , without regard to its conflict of law principles.

Entire Agreement: This form, together with any attachments or schedules expressly incorporated by reference, constitutes the entire agreement between the parties with respect to the removal described herein and supersedes all prior negotiations and understandings related to the subject matter.

Certifications and Additional Instructions

Provider Representative Name:     Provider Title:

Client Representative Name:     Client Title:

Sign Now