Identification Data Form

IDENTIFICATION DATA FORM

This Identification Data Form is incorporated into and made part of the General Business Agreement entered into by the parties. Effective Date:

WHEREAS

WHEREAS, Client Name: is engaged in lawful business and requires identification and contract information to be provided to Service Provider for the performance of services set forth in this Agreement;

WHEREAS, Service Provider Name: possesses the capability and agrees to provide services under the terms set forth herein; and

WHEREAS, the parties require a written record of identification data, contact information, and governing business terms to support the Agreement and to ensure compliance with applicable obligations.

IDENTIFICATION DATA

Individual Corporation LLC Partnership Other

SCOPE OF WORK

Provide a concise description of the services or deliverables to be performed by Service Provider pursuant to the Agreement:

PAYMENT TERMS

Total Contract Amount: $

Invoices due within days of invoice. Late payment will incur a late fee of per month or a flat fee of $ , whichever is greater, and reasonable collection costs, including attorneys' fees, if applicable.

TERM AND TERMINATION

Commencement Date:    Termination Date:

Either party may terminate this Agreement for convenience upon days' prior written notice. Termination for material breach is effective immediately upon written notice if the breaching party fails to cure within days after receipt of such notice.

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 that is designated as confidential or that reasonably should be understood to be confidential. Each party agrees to (a) use Confidential Information solely for performance under the Agreement; (b) restrict disclosure to employees and contractors with a need to know; and (c) employ reasonable safeguards to protect Confidential Information. Exceptions include information that is or becomes public through no breach, that is rightfully received from a third party, independently developed without use of the other party's Confidential Information, or required to be disclosed by law subject to prior notice where permitted.

The undersigned acknowledges and agrees to the Confidentiality obligations set forth above.

GOVERNING LAW

This Agreement, including this Identification Data Form, is governed by and shall be construed in accordance with the laws of the State of without regard to its choice-of-law principles. Venue for any dispute arising out of this Agreement shall be in the courts located in the same jurisdiction, unless otherwise agreed in writing.

ENTIRE AGREEMENT

This Identification Data Form and the General Business Agreement constitute the entire agreement between the parties with respect to the subject matter herein and supersede all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written. Any amendment must be made in a written instrument signed by authorized representatives of both parties.

REPRESENTATIONS AND CERTIFICATION

The undersigned hereby represents and certifies that all information provided on this Identification Data Form is true, complete and accurate to the best of their knowledge, and that they are authorized to provide such information on behalf of the named party. The undersigned will promptly notify the other party in writing of any material changes to the information provided.

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