Client Signature Consent Form

CLIENT SIGNATURE CONSENT FORM

Client Name:    Client Address:

Service Provider Name:    Service Provider Contact:

RECITALS

WHEREAS, Client desires to engage Service Provider to perform certain services as set forth in this agreement and to permit the use of Client's signature in electronic or reproduced form for documents reasonably related to the services; and

WHEREAS, Service Provider has represented that it is authorized and able to provide the services described below and implements commercially reasonable procedures to secure and preserve records that include Client's signature; and

WHEREAS, the parties desire to set forth their understanding regarding the use, scope, and retention of Client's signature and related consents.

SCOPE OF WORK

PAYMENT TERMS

Late fee:    Maximum allowable late fee:

TERM AND TERMINATION

This Agreement commences on Start Date: and continues until End Date: unless earlier terminated in accordance with this section.

CONFIDENTIALITY

Each party (the "Recipient") acknowledges that during the performance of services it may gain access to confidential or proprietary information of the other party (the "Discloser"). Recipient shall: (a) hold such information in strict confidence; (b) use it only to perform obligations under this Agreement; and (c) not disclose it to any third party except as expressly permitted in writing. Confidential information excludes (i) information in the public domain through no fault of Recipient, (ii) information rightfully received from a third party without restriction, and (iii) information independently developed by Recipient.

CONSENT TO USE OF SIGNATURE

Client hereby authorizes Service Provider to: (a) accept and retain an image, electronic reproduction, or facsimile of Client's signature for the limited purposes of executing routine documents and invoices related to the Scope of Work; and (b) affix Client's signature to ancillary documents solely as authorized in writing by Client.

Client acknowledges that an electronic signature that conforms to applicable electronic signature laws and the procedures employed by Service Provider is legally valid and binding to the same extent as a handwritten signature for documents covered by this consent.

Client expressly consents to the use of electronic signatures for documents and records relating to the Scope of Work.

Client authorizes Service Provider to store a reproduced version of Client's signature in encrypted or secure form for recordkeeping and to produce such reproduction as evidence of authorization when necessary.

REPRESENTATIONS AND WARRANTIES

Client represents and warrants that Client is authorized to grant the consents contained herein, that the signature provided is the lawful signature of the Client, and that no other person or entity's consent is required to permit the uses authorized by this Agreement. Service Provider represents that it will use reasonable administrative, technical and physical safeguards to protect records containing Client's signature from unauthorized access or disclosure.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of law principles.

ENTIRE AGREEMENT

This Agreement, together with any appendices or written amendments signed by both parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations, and understandings, whether oral or written.

MISCELLANEOUS PROVISIONS

Severability: If any provision of this Agreement is held invalid or unenforceable, the remainder of this Agreement shall continue in full force and effect. Waiver: No waiver of any breach shall be effective unless in writing and signed by the waiving party.

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