Initials Request Form

INITIALS REQUEST FORM

This Initials Request Form (the "Form") is entered into as of by and between:

WHEREAS

WHEREAS, the Requesting Party and the Responding Party entered into a separate agreement or documented relationship concerning services and deliverables, and the Requesting Party requires express, recorded initialing to confirm review and acceptance of particular sections of that agreement; and

WHEREAS, the Parties desire to set forth the scope of the review request, the sections to be initialed, the certification language accompanying each initial, and the effect of such initials on the Parties' mutual obligations;

WHEREAS, the Parties agree that initials provided in the spaces below shall constitute a contemporaneous acknowledgment and limited amendment acknowledgment as further described in this Form.

SCOPE OF WORK

PAYMENT TERMS

The Requesting Party shall pay the Responding Party the sum of USD in consideration for the services and administrative processing of initials as set forth in this Form.

Late payment shall incur a late fee equal to of the overdue balance per month, and interest shall accrue at the maximum lawful rate if permitted by applicable law. Failure to pay when due constitutes a material breach permitting suspension of services.

TERM AND TERMINATION

This Form commences on the Start Date: and shall continue until End Date: unless earlier terminated as provided below.

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

CONFIDENTIALITY

Each Party shall maintain in strict confidence all non-public information disclosed in connection with this Form, whether disclosed orally, in writing, or electronically, and shall not disclose such information to any third party except to its employees, contractors, or advisors who have a need to know and are bound by confidentiality obligations no less protective than those set forth herein. Confidential information does not include information that: (a) is or becomes publicly available through no fault of the receiving Party; (b) was already rightfully in the receiving Party's possession at the time of disclosure; or (c) is independently developed without use of the disclosing Party's confidential information.

INITIALS ACKNOWLEDGMENT

The Parties shall place their initials in the space provided next to each listed section or page to signify that they have reviewed and acknowledged the content of that section or page. Initialing a section shall constitute the signatory's limited acknowledgment of the content of that specific section only and shall not by itself constitute full execution of the underlying principal agreement unless otherwise expressly stated in that agreement.

Recitals — acknowledgment of factual background. Initials:

Scope of Work — services and deliverables. Initials:

Payment Terms — fees, schedule, and late fees. Initials:

Term & Termination provisions. Initials:

Confidentiality provisions. Initials:

Entire Agreement clause and miscellaneous provisions. Initials:

Each initial placed by a Party is a representation that the Party has reviewed the referenced section and that the initialing Party accepts the referenced language subject to any express limited exceptions noted in writing on the signature page. Initials shall be deemed a part of the Parties' contemporaneous documentation and may be relied upon as evidence of the Parties' understanding of the referenced sections.

GOVERNING LAW

This Form shall be governed by and construed in accordance with the laws of the State of , without regard to its conflict of laws principles. The Parties submit to the exclusive jurisdiction of the courts located within that State for disputes arising out of this Form.

ENTIRE AGREEMENT

This Form, together with any document expressly incorporated by reference and any initials or notations made pursuant to it, constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations, and discussions, whether oral or written, relating to the same subject matter.

No amendment or modification of this Form will be effective unless in writing and signed by authorized representatives of both Parties. The Parties acknowledge that electronic initials and signatures applied through an agreed process are intended to have the same force and effect as handwritten initials and signatures.

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