Eligible Registration Form

ELIGIBLE REGISTRATION FORM

RECITALS

WHEREAS, Registrant Name: seeks registration as eligible under the terms and conditions set forth in this Eligible Registration Form; and

WHEREAS, Registrar Name: administers the registry and will assess eligibility, accept registrations, and administer related agreements;

WHEREAS, the parties agree that registration of the Registrant as eligible will be governed by the terms below, including scope of work, payment obligations, confidentiality, and governing law, effective as of Effective Date:

APPLICANT INFORMATION

Individual   Sole Proprietorship   Limited Liability Company (LLC)   Corporation   Partnership   Other:

ELIGIBILITY CRITERIA & CERTIFICATIONS

By checking the boxes below and signing this form, the Registrant certifies under penalty of perjury that the following statements are true, complete, and accurate:

Registrant is currently active and in good standing with all required registrations and licenses applicable to its operations.
Registrant is not suspended, debarred, or otherwise excluded from participation in programs substantially similar to the services sought herein.
Registrant will comply with all applicable laws, regulations, and standards relevant to performance under any agreement arising from this registration.

SCOPE OF WORK

Description of Services to be Provided (if registration leads to engagement). Provide a clear, concise description of services, deliverables, milestones, and performance standards. If left blank, registration authorizes Registrar to solicit scope agreements prior to engagement.

PAYMENT TERMS

Registrant acknowledges that registration may create payment obligations for services performed under subsequent statements of work. The parties agree the following baseline payment terms:

All invoices are due as set forth in applicable statements of work. Registrant shall be responsible for reasonable collection costs, including interest and attorney fees, for overdue amounts. Payment obligations are subject to adjustment by mutual written agreement.

TERM AND TERMINATION

This registration and any agreement arising from it shall commence on Start Date: and continue until End Date: unless earlier terminated in accordance with this section.

Either party may terminate for convenience by providing written Notice Period (days): prior written notice. Either party may terminate immediately for material breach if such breach is not cured within the lesser of the notice period or fifteen (15) days after receipt of written notice describing the breach.

CONFIDENTIALITY

Each party shall maintain in confidence all nonpublic information disclosed by the other party 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 ("Confidential Information"). Confidential Information does not include information that is publicly known through no fault of the receiving party, independently developed by the receiving party without use of the disclosing party’s Confidential Information, or required to be disclosed by law.

The receiving party shall use Confidential Information solely for the purposes of performing obligations under any agreement arising from this registration, shall take reasonable measures to protect confidentiality, and shall return or destroy Confidential Information upon written request.

I acknowledge and agree to the confidentiality obligations set forth above.

GOVERNING LAW

This Eligible Registration Form and any agreements arising from it shall be governed by and construed in accordance with the laws of the State of: without regard to conflict of law principles. The parties submit to the exclusive jurisdiction of the federal and state courts located in that State for any dispute arising out of or relating to this Form.

ENTIRE AGREEMENT

This Eligible Registration Form, together with any attached schedules or subsequently executed statements of work signed by authorized representatives of both parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral.

MISCELLANEOUS PROVISIONS

Any waiver of a breach or default under this Form must be in writing signed by the waiving party. If any provision is held invalid or unenforceable, the remaining provisions remain in full force and effect. Headings are for convenience only and do not affect interpretation.

ACKNOWLEDGMENT AND AUTHORITY

Each individual signing below represents and warrants that they are authorized to execute this Eligible Registration Form on behalf of the party for which they sign and that their signature binds that party to the terms herein.

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