Information Request Form

INFORMATION REQUEST FORM

RECITALS

WHEREAS, Requester: (the "Requester") seeks access to documents, records, data, or other information described in this form; and

WHEREAS, Recipient/Provider: (the "Provider") maintains or controls such information and is willing to provide the requested information subject to the terms set forth herein; and

WHEREAS, the parties desire to memorialize the scope, payment, confidentiality, and delivery obligations associated with the Request effective as of: .

REQUESTER INFORMATION

RECIPIENT / RECORDS CUSTODIAN

REQUEST DETAILS

Date of Request:

SCOPE OF WORK

The Provider shall locate, collect, review, and produce the records described above consistent with applicable laws and the delivery method selected. The work shall include redaction for legally protected material, indexing of produced materials, and a certificate of completeness as required below.

PAYMENT TERMS

The Requester agrees to pay the Provider the fees reasonably incurred in locating, duplicating, and delivering the requested information. Estimated total: .

Late payment shall accrue interest at a rate of on unpaid balances, and the Provider may suspend delivery of remaining materials until payment is received.

TERM AND TERMINATION

Term Commencement: . Termination Date (if any): .

Either party may terminate this request for convenience upon written notice delivered at least prior to the effective termination date. Termination will not relieve the Requester of payment for work performed or records produced prior to termination.

CONFIDENTIALITY

For purposes of this agreement, "Confidential Information" means nonpublic information disclosed in connection with this request, including but not limited to personally identifiable information, trade secrets, proprietary business information, and privileged communications. The receiving party shall:

1. Protect Confidential Information with at least the same degree of care it uses for its own confidential materials;
2. Not use Confidential Information except to perform obligations under this form;
3. Limit disclosure to employees, contractors, or agents who have a need to know and are bound by confidentiality obligations at least as protective as those herein;
4. Promptly notify the disclosing party of any unauthorized access, use, or disclosure of Confidential Information.

The obligations above do not apply to information that is (a) in the public domain through no fault of the recipient, (b) lawfully obtained from a third party, (c) independently developed without use of Confidential Information, or (d) required to be disclosed by law or valid legal process, provided the disclosing party is given prompt notice when permissible.

GOVERNING LAW

This form and any dispute arising out of or relating to it shall be governed by the laws of: , without regard to conflict of law principles.

ENTIRE AGREEMENT

This Information Request Form, together with any exhibits or attachments expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior and contemporaneous agreements, understandings, negotiations, and communications, whether written or oral. No amendment or waiver shall be effective unless in writing and signed by authorized representatives of both parties.

CERTIFICATIONS

By submitting this request and by their signatures below, each party certifies that they have the authority to enter into this form, that the information provided is true and complete to the best of their knowledge, and that they will comply with the terms set forth herein.

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