Customer Verification Questions

Customer Verification Questions — General Business Agreement

Parties and Recitals

This Agreement is made and entered into as of (the Effective Date), by and between:

Client Name: , with principal address

Provider Name: , with principal address

WHEREAS, Client seeks verification of certain customer identity and business information to permit Provider to perform the services described below; and

WHEREAS, Provider is willing to obtain and rely upon the verification information provided by Client subject to the terms and conditions of this Agreement.

Customer Verification Questions (to be completed by Client)

Individual Corporation Limited Liability Company (LLC) Trust Other:

Type: Number: Issuing Jurisdiction:

By checking the box below, Client certifies that the information provided in this Customer Verification Questions form is true, complete and accurate to the best of Client's knowledge and that Client will promptly notify Provider in writing of any material changes.

I certify the information provided is accurate and complete.

Scope of Work

Provider will perform identity and verification services, review of documents supplied by Client, risk assessment as described below, and related advisory services necessary to permit Provider to render the agreed deliverables. Specific tasks, deliverables, and reporting frequency shall be as set forth in the Scope of Work field.

Payment Terms

If any undisputed amount remains unpaid beyond the agreed payment due date, Provider may assess a late fee of on the outstanding balance, or a fixed late fee of , whichever is greater.

Term and Termination

This Agreement commences on and shall continue until unless earlier terminated in accordance with this Section.

Either party may terminate this Agreement for convenience upon days' prior written notice to the other party. Termination for material breach may be effective immediately if the non-breaching party provides notice and the breach is not cured within a commercially reasonable cure period.

Confidentiality

Each party acknowledges that in the course of performing under this Agreement it may receive Confidential Information of the other party. "Confidential Information" means non-public information designated as confidential or that reasonably should be understood to be confidential. The receiving party shall (a) hold Confidential Information in strict confidence, (b) use Confidential Information solely for performance of this Agreement, and (c) limit access to those employees, agents or contractors who need access to perform this Agreement and who are bound by confidentiality obligations no less protective than this Agreement. Confidential Information does not include information that is or becomes generally available to the public other than by breach of this Agreement, was known to the receiving party without restriction prior to disclosure, or was independently developed without use of or reference to the disclosing party's Confidential Information. Reasonable disclosures required by law or regulatory process are permitted with prior notice to the disclosing party where lawful.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the state or jurisdiction agreed by the parties below. The parties agree that any disputes arising out of or relating to this Agreement shall be resolved in the courts of that jurisdiction unless the parties mutually agree to binding arbitration.

Entire Agreement

This Agreement, including any attachments and the completed Customer Verification Questions, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations, and understandings of the parties. Any amendment or modification must be in writing and signed by both parties.

Representations and Certifications

Each party represents and warrants that it has full corporate or individual authority to enter into this Agreement, that the information it provides is true and correct, and that execution of this Agreement will not violate any agreement with a third party. Client certifies that it will promptly notify Provider of any material change to the verification information provided.

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