Final Payment Authorization Form

FINAL PAYMENT AUTHORIZATION FORM

Parties and Recitals

This Final Payment Authorization Form is entered into by and between Client Name: with address: and Payee Name: with address: .

WHEREAS, the parties entered into a written agreement identified as Agreement Reference: dated , for the performance of the work described below; and

WHEREAS, Payee certifies that all services and deliverables under the Agreement have been completed and that this authorization will constitute the final payment and full settlement of amounts due subject to the terms below.

Scope of Work

Payment Terms

Total Contract Value: $ | Prior Payments Received: $ | Final Payment Amount: $ .

Payment Due Date: . Late payment shall incur a fee of on any unpaid balance after from the due date, together with all collection costs and reasonable attorney fees.

Check    Wire Transfer    ACH    Credit Card

Term and Termination

Contract Commencement Date: | Contract Completion / Termination Date: .

Either party may terminate this authorization for cause upon written notice to the other party. Termination without cause requires prior written notice. Final payment obligations that have accrued prior to termination shall remain payable in accordance with the Payment Terms above.

Confidentiality

Each party shall maintain in confidence all nonpublic information disclosed in connection with the Agreement or this Final Payment Authorization and shall not disclose such information except as required by law or with the prior written consent of the other party. This obligation survives final payment and termination of the Agreement for a period of .

Representations; Release; Liens

By signing below, Payee represents and warrants that all labor, services, materials and subcontractor obligations have been paid and discharged, and that there are no outstanding claims, liens or encumbrances against the work for which this final payment is due, except as expressly noted in the field below.

Upon receipt of the Final Payment Amount set forth above, Payee shall be deemed to have released and waived any right to assert mechanic's liens, stop notices, or other claims against Client arising from the Agreement to the maximum extent permitted by law.

Governing Law; Entire Agreement

This Final Payment Authorization shall be governed by and construed in accordance with the laws of the State of , without regard to its conflict of laws principles.

This form, together with the underlying Agreement identified above, constitutes the entire agreement and understanding between the parties with respect to the subject matter hereof and supersedes all prior negotiations, representations and agreements, whether written or oral.

Certification and Authorization

The undersigned authorized representative of Client authorizes release of Final Payment Amount set forth above to Payee in accordance with the Payment Terms. Client certifies that the work has been completed to Client's satisfaction, except as expressly noted in this document.

The undersigned authorized representative of Payee certifies that the statements in this form are true and correct, that all subcontractors and suppliers have been paid in full for work related to the final payment except as noted, and that Payee will, upon receipt of final payment, release claims as set forth above.

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