Client Signature Application Form

CLIENT SIGNATURE APPLICATION FORM

This Client Signature Application Form and Agreement (the Agreement) is made effective as of by and between Client Name: and Service Provider Name: .

WHEREAS

WHEREAS, Client seeks to obtain authorization for designated signatory authority and acceptance of specified services to be performed by Service Provider under the terms set forth herein; and

WHEREAS, Service Provider represents that it has the experience, personnel, and resources necessary to perform the services described in this Agreement and agrees to accept the application and related documents submitted by Client for signature authorization and service engagement; and

WHEREAS, the parties desire to set forth the terms, payment, confidentiality, and governing law provisions applicable to the services and signature authorization described below.

CLIENT CONTACT INFORMATION

SCOPE OF WORK

Service Provider will perform the services described below and shall possess authority to sign certain documents on behalf of Client only to the extent expressly set forth in writing. Client authorizes signature authority solely as provided herein and subject to the conditions in this Agreement.

PAYMENT TERMS

In consideration for the services described in the Scope of Work, Client shall pay Service Provider the fees set forth below. All payments are due in accordance with the schedule below. Late payments shall incur the late fee specified and interest as provided.

If any undisputed payment is not received by Service Provider within days after the due date, Client shall pay a late fee equal to % per month on the unpaid balance (or the maximum permitted by law, if lower). Service Provider may also recover reasonable collection costs, including attorneys' fees.

TERM AND TERMINATION

This Agreement shall commence on Start Date: and continue until End Date: unless earlier terminated in accordance with this section.

Either party may terminate this Agreement for convenience upon written notice delivered no less than days to the other party. Either party may terminate immediately for material breach by the other party if such breach is not cured within 15 days after written notice of breach.

CONFIDENTIALITY

Each party acknowledges that during the term of this Agreement it may receive Confidential Information from the other party. "Confidential Information" means non-public information that is designated as confidential or that reasonably should be understood to be confidential. Each party shall (a) use Confidential Information solely to perform its obligations or exercise its rights under this Agreement; (b) restrict disclosure of Confidential Information to employees and agents who have a need to know and who are bound by confidentiality obligations at least as protective as those herein; and (c) protect Confidential Information using at least the same degree of care it uses to protect its own confidential information, but never less than reasonable care. Confidential Information shall not include information that is or becomes publicly known through no wrongful act, is rightfully received from a third party without breach of any obligation of confidentiality, or is independently developed without use of the other party’s Confidential Information.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflicts of law rules. The parties waive any jury trial to the fullest extent permitted by law.

ENTIRE AGREEMENT

This Agreement, including all exhibits and attachments executed by the parties, constitutes the entire agreement between the parties with respect to its subject matter and supersedes all prior and contemporaneous agreements, proposals, or representations, whether written or oral. Any modification to this Agreement must be in writing and signed by authorized representatives of both parties.

CERTIFICATION AND AUTHORIZATION

By signing below, each signatory certifies under penalty of perjury that they are authorized to enter into this Agreement on behalf of the party identified, that the information provided in this application is true and complete, and that they consent to the terms contained herein. Any signature authority granted to Service Provider is limited to those acts expressly specified in the Scope of Work and expires upon termination of this Agreement unless expressly extended in writing.

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