Customer Support Request Form

CUSTOMER SUPPORT REQUEST FORM

Recitals

WHEREAS, Client Name: (hereinafter "Client") requires technical support, maintenance, or other customer support services related to software, systems, or services; and

WHEREAS, Support Provider Name: (hereinafter "Provider") is willing to provide such support in accordance with the terms set forth below and the scope described in this request form.

NOW, THEREFORE, the parties submit this Customer Support Request Form and agree that the requested support and any subsequent provision of services will be governed by the terms in this form and the attached/service order terms.

Requester Information

Email    Phone    Support Portal    Other

Support Request Details

Incident / Outage    Service Request    Change Request    Billing / Account    Other

Desired resolution or target date:

Scope of Work

Provider Responsibilities: Provider will evaluate, troubleshoot, and take commercially reasonable actions to resolve the reported issue consistent with Provider's accepted practices. Provider will provide root cause analysis where applicable, document corrective actions, and, when required, coordinate with the Client for on-site or remote remediation.

Payment Terms

Fees for support provided under this request are payable as set forth below. Unless otherwise specified in a separate agreement, fees are due in accordance with the schedule elected by Client and invoiced by Provider.

Late Payment Fee: . Client agrees that overdue amounts accrue interest or fees as stated and Provider may suspend services for nonpayment in accordance with the notice provisions below.

Term and Termination

This request and any related service obligations commence on Start Date: and remain in effect until End Date: unless earlier terminated pursuant to this section.

Either party may terminate this request for material breach of its terms if the breaching party fails to cure such breach within Notice Period (days): days after receipt of written notice. Termination does not relieve Client's obligation to pay for services performed prior to the effective date of termination.

Confidentiality

Each party acknowledges that during the course of the provision of services it may receive Confidential Information of the other party. Confidential Information means non-public information disclosed in written, electronic or oral form that is designated as confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure. Each party shall: (a) use Confidential Information solely for the purpose of performing obligations under this request; (b) restrict disclosure to employees, contractors, and agents who have a need to know and are bound by confidentiality obligations at least as protective as those herein; and (c) not disclose Confidential Information to any third party without prior written consent, except as required by law. Confidential Information does not include information that is publicly known without breach, rightfully received from a third party, independently developed, or required to be disclosed by law with prior notice where permitted.

Governing Law

This request and any dispute arising out of or in connection with it shall be governed by the laws of State: without regard to conflicts of laws principles. The parties submit to the exclusive jurisdiction of competent courts located within that state for the resolution of disputes.

Entire Agreement

This Customer Support Request Form, together with any executed service order, statement of work, or exhibits expressly incorporated herein, constitutes the entire agreement between Client and Provider with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, and communications, whether oral or written. Any amendment must be in writing and signed by authorized representatives of both parties.

Acknowledgement

By signing below, the parties acknowledge that they have read, understand, and agree to be bound by the terms of this Customer Support Request Form and that the information provided herein is accurate to the best of their knowledge.

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