Document Scanning Request Form

DOCUMENT SCANNING REQUEST FORM

Parties and Effective Date

Client Name:    Client Address:

Service Provider Name:    Provider Address:

Effective Date:

WHEREAS

WHEREAS, Client requires conversion of physical documents into electronic format and associated indexing and delivery services; and

WHEREAS, Service Provider represents that it has the necessary equipment, personnel, controls and experience to perform secure document scanning, indexing, and delivery in accordance with the terms set forth herein;

NOW, THEREFORE, in consideration of the mutual promises contained in this Request Form and other good and valuable consideration, the parties agree as follows.

Scope of Work

Number of Boxes / Units:    Estimated Total Pages:

Scanning Specifications:

Color Options: Color Grayscale Black & White

Resolution / OCR:    OCR Required: Yes

File Format(s): PDF TIFF JPG Other    

Indexing Method:

Logistics and Handling

Chain of Custody Options: On-site pickup Client drop-off Courier transfer

Return or Disposal of Originals: Return originals to Client Secure shredding (certificate upon request)    If shredding, hold originals for days before destruction.

Payment Terms

Total Estimated Fee: $ (actual billed on final page count and services)

Billing Schedule:

Payment Due: Net days from invoice date. Late payments shall incur a late fee of per month on the unpaid balance or the maximum permitted by law, whichever is less.

Client agrees to pay all reasonable collection costs, including attorneys' fees, if payment is not made in accordance with the terms above.

Term and Termination

Term Start Date:    Term End Date:

Either party may terminate this Request Form for material breach if the breaching party fails to cure such breach within days of receipt of written notice. Either party may also terminate for convenience upon providing days' prior written notice. Client remains responsible for fees for work performed through the effective termination date.

Confidentiality and Data Security

Service Provider shall treat all materials and information provided by Client as Confidential Information. Provider agrees to implement administrative, physical and technical safeguards appropriate to the risk, including but not limited to controlled access to scanning areas, secure transfer protocols, encryption of files in transit and at rest where applicable, background-checked personnel, and retention of chain-of-custody records. Specific security measures requested by Client:

Provider shall not disclose Confidential Information except as required by law or as necessary to perform the services and shall ensure that any subcontractors are bound by written confidentiality obligations no less protective than those herein.

Representations, Warranties and Liability

Provider warrants that scans will materially conform to the specifications agreed in this Request Form and that Provider will exercise reasonable care in handling originals. Provider's aggregate liability for claims arising out of this engagement shall not exceed the fees paid by Client under this Request Form with respect to the affected materials, except in cases of willful misconduct or gross negligence. Provider is not responsible for pre-existing damage or illegibility of originals. Client represents that it has the right to authorize scanning and transfer of the provided materials and will indemnify Provider against third-party claims arising from Client's materials or instructions.

Governing Law; Entire Agreement

This Request Form shall be governed by and construed in accordance with the laws of the state specified here: , without regard to conflict of law principles. This Request Form, together with any attached statements of work, constitutes the entire agreement between the parties relating to the subject matter and supersedes all prior understandings and agreements, whether written or oral.

Special Provisions / Notes

Acknowledgment: By signing below, each party acknowledges that it has read and understands this Request Form, has the authority to enter into it, and agrees to be bound by its terms.

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