Financial Income Sheet

FINANCIAL INCOME SHEET

This Financial Income Sheet and Services Agreement is entered into between Client Name: and Service Provider Name: . The parties set forth the financial information and related terms below to support the services described in the Scope of Work.

RECITALS

WHEREAS, Client requires accurate and verifiable financial income information for evaluation, underwriting, reporting, or advisory services; and

WHEREAS, Service Provider will collect, compile, and certify the income information provided by Client, and may rely on such data to produce reports, statements, or analyses as set forth in the Scope of Work; and

NOW, THEREFORE, the parties agree that the following financial income disclosures, representations, and contractual terms shall govern their relationship.

FINANCIAL INCOME DETAILS

SUMMARY OF INCOME

Total Gross Monthly Income:    Total Gross Annual Income:

SUPPORTING DOCUMENTS

Check documents attached/provided (select all that apply):

Pay stubs (most recent)

Tax returns (most recent year)

Bank statements (last 2-3 months)

Profit & loss statement (self-employed)

Other (describe)

SCOPE OF WORK

Service Provider will perform the following services with respect to the financial income information provided by Client:

PAYMENT TERMS

Fee Amount:

Payment Schedule:

Late Fee and Collections: Unpaid amounts shall incur a late fee of on outstanding balances, and Client shall be responsible for reasonable collection costs and attorneys' fees.

TERM AND TERMINATION

Effective Date:    Term End Date:

Either party may terminate this Agreement for material breach by the other party upon written notice and a thirty (30) day opportunity to cure. Termination does not relieve Client of payment obligations for services performed prior to termination.

CONFIDENTIALITY

All non-public financial information disclosed by Client to Service Provider in connection with this Agreement shall be treated as Confidential Information. Service Provider will not disclose such information except to employees, contractors, or affiliates with a need to know, or as required by law. Service Provider will employ commercially reasonable safeguards to protect Confidential Information.

CERTIFICATION & AUTHORIZATION

Client certifies that the income and financial statements provided are true, complete, and accurate to the best of Client's knowledge. Client acknowledges that material misrepresentation or omission of information may constitute fraud and may subject Client to civil or criminal penalties.

Client authorizes Service Provider to verify income, employment, bank records, tax returns, and other information with third parties and to order such verifications or reports as reasonably necessary to perform the Scope of Work. Client further authorizes third parties to release such information to Service Provider.

GOVERNING LAW

This Agreement and any dispute arising out of or related to it shall be governed by and construed in accordance with the laws of the state of , without regard to conflict of law principles.

ENTIRE AGREEMENT

This Financial Income Sheet, together with the Scope of Work and any attachments executed by the parties, constitutes the entire agreement between Client and Service Provider concerning the subject matter hereof and supersedes all prior negotiations, representations, or agreements, whether written or oral. Any amendment must be in writing and signed by both parties.

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