Customer Setup Questionnaire

Customer Setup Questionnaire and Service Agreement

Provider Name:    Customer Name:

WHEREAS

WHEREAS, the Provider is engaged in the business of providing services and solutions specified in this agreement and possesses personnel, systems and resources necessary to perform such services; and

WHEREAS, the Customer requires Provider assistance to perform onboarding, system configuration and related services and has supplied information to facilitate such setup; and

WHEREAS, the parties desire to document the scope of services, fees, confidentiality obligations, and other terms governing the relationship as set forth below.

CUSTOMER INFORMATION

Individual    Corporation    LLC    Partnership    Nonprofit    Other:

Email    Phone    Client Portal    Other:

ONBOARDING CHECKLIST

Please indicate which documents or items will be provided for setup:

W-9 or equivalent tax form    Certificate of insurance    Signed service agreement    Bank account details (for ACH)

SCOPE OF WORK

The Provider shall perform the setup and configuration services, data migration, testing and initial training necessary to place Customer systems into normal operation as described below. Specific tasks, deliverables, and completion criteria are to be set forth in the Scope of Work entry provided by the parties.

PAYMENT TERMS

Fees for services shall be as set forth below. All amounts are due in U.S. dollars unless otherwise agreed in writing.

All invoices not paid within the stated payment terms shall accrue interest at the rate specified above and Provider may suspend services until outstanding amounts are paid in full. Customer is responsible for reasonable collection costs incurred by Provider for delinquent accounts.

TERM AND TERMINATION

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

Either party may terminate this Agreement for material breach by the other party if the breach remains uncured for the notice period specified above following receipt of written notice. Provider may also terminate immediately for nonpayment. Termination shall not relieve Customer of its obligation to pay accrued fees for services performed through the termination date.

CONFIDENTIALITY

Each party acknowledges that in connection with this Agreement it may receive Confidential Information of the other party. Confidential Information shall include business, technical and financial information disclosed in written, oral or electronic form. Each party agrees to: (i) hold Confidential Information in confidence using at least the same degree of care it uses to protect its own confidential information but in no event less than reasonable care; (ii) not disclose Confidential Information to any third party except to employees, contractors and advisors who have a need to know and are bound by confidentiality obligations; and (iii) use Confidential Information solely to perform its obligations under this Agreement. Confidentiality obligations shall survive termination for a period of three (3) years, except with respect to trade secrets which shall be protected for as long as such information remains a trade secret under applicable law.

GOVERNING LAW AND DISPUTE RESOLUTION

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to conflict of laws principles. The parties shall attempt in good faith to resolve disputes promptly through escalation and negotiation. If unresolved, disputes shall be resolved in the state or federal courts located in the jurisdiction specified above.

ENTIRE AGREEMENT

This document, together with any attached Scope of Work and exhibits executed by the parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, negotiations and communications, whether oral or written. Any amendment or modification must be in writing and signed by authorized representatives of both parties.

ADDITIONAL SETUP DETAILS

The undersigned represent and warrant that the information provided in this questionnaire is accurate and complete to the best of their knowledge, and that they have the authority to bind the party on whose behalf they sign. The parties agree that submission of this questionnaire and execution of the signature block below shall be effective to authorize Provider to proceed with the onboarding and initial provisioning activities described herein, subject to the terms of this Agreement.

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