Legal E-Sign Disclosure Form

Legal E-Sign Disclosure Form

This Legal E-Sign Disclosure Form (the "Disclosure") is entered into as of by and between Client Name: ("Client") and Provider Name: ("Provider").

RECITALS

WHEREAS, Provider and Client anticipate the transmission, execution and storage of certain agreements, notices, disclosures and other records in electronic form in connection with the business relationship between the parties; and

WHEREAS, the parties desire to establish their respective rights and obligations with respect to the use of electronic signatures and electronic records, including the manner in which electronic records will be delivered, retained, and withdrawn; and

WHEREAS, the parties intend that electronic signatures executed in accordance with this Disclosure will have the same force and effect as manual, handwritten signatures for all purposes and for all records covered by this Disclosure.

NOW, THEREFORE, in consideration of the mutual covenants set forth herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Disclosure, the following terms have the meanings set forth below: "Electronic Record" means any record or document provided in electronic form; "Electronic Signature" means any electronic symbol, sound or process attached to or logically associated with an Electronic Record and executed or adopted by a person with the intent to sign the record; "Delivery" and "Deliver" include transmission by electronic means consistent with the delivery provisions of this Disclosure.

2. CONSENT TO ELECTRONIC SIGNATURES AND RECORDS

By selecting the affirmative consent below and executing this Disclosure, Client expressly consents to the use of Electronic Signatures and Electronic Records in lieu of handwritten signatures and paper records for any documents that Provider may deliver or require to be executed in connection with the parties' transactions. This consent applies to all documents, notices and disclosures related to the business relationship unless a particular document specifically states otherwise.

Consent to electronic records and signatures: I consent to receive and sign documents electronically

3. HARDWARE AND SOFTWARE REQUIREMENTS

Client acknowledges that access to Electronic Records and the ability to sign electronically will require certain hardware and software. At minimum, Client must have: (a) a computer, tablet or mobile device capable of accessing email and opening PDF or common document formats; (b) a current web browser or application capable of displaying and printing PDF documents; and (c) a valid email account. Client represents that Client has the necessary equipment and ability to access and retain electronic records.

If Client cannot access or retain an Electronic Record due to a change in hardware or software, Client may request a paper copy as provided in Section 5.

4. SCOPE OF CONSENT; TYPES OF DOCUMENTS

Client's consent covers all current and future agreements, consents, disclosures, notices, amendments, statements, invoices, and related documents which Provider presents for electronic signature or electronic delivery, unless a specific document requires separate consent. Examples of covered documents include enrollment forms, service agreements, amendments, waivers and transaction confirmations.

5. DELIVERY, RECEIPT, AND PAPER COPY OPTION

Electronic Records will be delivered to the email address provided by Client or made available through a secure online portal. Client agrees that delivery by email or access to a portal constitutes receipt for all purposes. Client may request a paper copy of any Electronic Record. To request a paper copy, Client must contact Provider as provided in the Notices section and Provider will provide a paper copy within a commercially reasonable time and may charge a reasonable fee for reproduction and delivery.

6. WITHDRAWAL OF CONSENT

Client may withdraw consent to electronic communications at any time by providing written notice to Provider as set forth in the Notices section. Withdrawal of consent will be effective only after Provider has had a reasonable period to process the withdrawal. Provider's ability to continue providing services following withdrawal of consent may be subject to additional terms, and Provider may require paper signatures where permitted by law.

Email notice to Provider
Written notice by mail
Telephone notice followed by written confirmation

7. SECURITY, AUTHENTICATION AND RECORD RETENTION

Provider will use commercially reasonable security measures to protect the integrity and confidentiality of Electronic Records. Provider may use authentication measures including unique links, access codes, multi-factor authentication, or other identity verification methods. Provider will retain electronic copies of executed documents in accordance with its record retention policy and applicable law. Client acknowledges that certain jurisdictions impose legal requirements for retention and that Provider's retention period shall satisfy applicable law.

8. NOTICES

All notices required or permitted under this Disclosure shall be given in writing by email, personal delivery, or certified mail to the addresses provided by the parties. Notices delivered electronically are effective upon Provider's successful transmission or delivery confirmation, and notices delivered by mail are effective upon receipt.

9. REPRESENTATIONS AND WARRANTIES

Each party represents and warrants that it has the full legal capacity and authority to enter into this Disclosure and to grant the consents and perform the obligations herein. Client further represents that any information provided for the purpose of electronic delivery, including email and mailing address, is accurate and will be kept reasonably current.

10. AMENDMENTS; WAIVER

This Disclosure may be amended only by a written instrument executed by both parties. No failure or delay by either party in exercising any right will operate as a waiver of that right, and any waiver must be in writing and signed by the waiving party.

11. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

This Disclosure shall be governed by and construed in accordance with the substantive laws of the jurisdiction selected by the parties in the related transaction documents or, if none is selected, the laws of the state in which Provider maintains its principal place of business, without regard to conflict of law principles. If any provision of this Disclosure is held invalid or unenforceable, the remaining provisions shall remain in full force and effect. This Disclosure, together with any documents expressly incorporated herein, constitutes the entire agreement of the parties with respect to its subject matter and supersedes all prior understandings and agreements.

12. COUNTERPARTS

This Disclosure may be executed in counterparts, each of which will be deemed an original and all of which together will constitute one and the same instrument. Facsimile or electronic copies of signatures will be effective as originals.

ACKNOWLEDGMENT

By signing below, Client acknowledges that Client has read and understands the terms of this Disclosure, has the necessary equipment to access and retain Electronic Records, and consents to receive and sign documents electronically in accordance with this Disclosure.

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