Commission Payment Recognition Form

COMMISSION PAYMENT RECOGNITION FORM

Recognition Date:

Payer Name:    Payee Name:

Payer Address:

Payee Address:

WHEREAS

WHEREAS, Payee rendered services and procured sales on behalf of Payer under the parties' prior agreement and/or course of performance for the period beginning through (the "Sales Period");

WHEREAS, the parties acknowledge that, as of the Recognition Date, Payee has satisfied the performance criteria set forth and has earned a commission based on transactions identified in Schedule A, and Payer intends to recognize and pay such commission subject to the terms below.

SCOPE OF WORK / COMMISSION BASIS

PAYMENT TERMS

Commission Amount Due: $    Commission Rate:

Applicable Invoice / Reference No.:

Payment Method: Check Wire Transfer ACH

Payment Due Date:    Payment Schedule Details:

Late Payment Fee:

Deductions and Withholding: Payer reserves the right to deduct or withhold amounts required by law, including taxes and benefit contributions. Does withholding apply? Yes No

Adjustment for Returns or Credits: If any portion of the underlying sales is returned, credited, or subsequently disallowed within days, Payer may adjust commission consistent with the parties' policies.

TERM AND TERMINATION

Effective Date:    Termination Date (if applicable):

Notice Period for Termination: days prior written notice required.

Consequences of Termination: Upon termination, Payer shall pay any commissions earned and undisputed as of the termination effective date in accordance with the Payment Terms above, subject to allowed deductions, offsets for advances, and applicable taxes.

CONFIDENTIALITY

The parties acknowledge that commission calculations, supporting sales data, pricing, customer lists, and related materials are confidential business information. Each party shall hold such information in confidence, shall limit disclosure to those with a need to know, and shall not disclose or use the information except to effectuate the payment contemplated herein or as required by law.

GOVERNING LAW

This Form and any dispute arising under or related to it shall be governed by and construed in accordance with the laws of without regard to conflict of laws principles.

ENTIRE AGREEMENT

This Form constitutes the entire agreement between the parties concerning the recognition and payment of the commission identified herein. It supersedes all prior oral or written communications relating to the specific commission recognized, except to the extent expressly incorporated by reference.

CERTIFICATION AND ACKNOWLEDGMENT

By signing below, each party certifies that the statements and amounts set forth in this Form are true and accurate to the party's knowledge, that the commission identified has been earned consistent with applicable agreements and policies, and that the parties will take all actions necessary to effect payment in accordance with the Payment Terms. Acceptance of payment as described herein shall not, by itself, waive any defenses for fraud or material misrepresentation.

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