Legal Signature Request

LEGAL SIGNATURE REQUEST

This Legal Signature Request (the "Request") is entered into as of by and between Client Name: with principal address: and Service Provider Name: with principal address: (each a "Party" and collectively the "Parties").

RECITALS

WHEREAS, the Parties intend to execute certain documents and instruments described in Attachment A (the "Documents") and wish to establish the authority, procedures and acknowledgements governing the execution, delivery and retention of such Documents;

WHEREAS, each Party desires to grant specific authority for execution of the Documents, to confirm the validity of signatures (including electronic signatures), and to allocate responsibility for retention, delivery and reliance on executed Documents; and

WHEREAS, the Parties desire that the Requests and any signature provided in response to this Request be binding, enforceable and admissible as evidence in accordance with applicable law.

NOW, THEREFORE, in consideration of the mutual covenants herein and other good and valuable consideration, the Parties agree as follows:

1. AUTHORIZATION TO SIGN

1.1 Authority. Client hereby authorizes Service Provider to execute, deliver and effectuate the Documents on Client's behalf to the extent specified in Attachment A. Service Provider represents that any person executing a Document on behalf of a Party has the authority to bind that Party.

1.2 Scope. The authorization granted hereunder is limited to the Documents listed in Attachment A and to those amendments, supplements or ancillary instruments necessary to give effect to the Documents as executed. Any execution outside that scope requires a separate written authorization signed by the authorizing Party.

2. ELECTRONIC SIGNATURES

2.1 Consent to Electronic Execution. The Parties consent that signatures in electronic form (including by typed name, electronic signature platform, scanned signature, or other digital methods) are effective and constitute original signatures for all purposes, including enforcement and admissibility in legal proceedings.

2.2 Electronic Signature Methods. The Parties acknowledge that execution may occur by checking the acceptance box below, by signature on an electronic signature platform, or by other electronic means as agreed. The Party executing electronically warrants that the signature is their own and that the method used reasonably identifies the signatory and demonstrates intent to sign.

Consent to electronic signature and electronic delivery: I consent to execution by electronic signature

3. REPRESENTATIONS AND WARRANTIES

3.1 Each Party represents and warrants that: (a) it is duly organized and validly existing; (b) it has full power and authority to enter into this Request and to authorize the execution and delivery of the Documents; (c) the execution and delivery of the Documents and the performance of its obligations will not violate any law, contractual restriction or other obligation binding on such Party.

3.2 Reliance. Each Party may rely conclusively upon a Document that bears the signature of a Party as authorized by this Request and is entitled to treat any such Document as duly executed.

4. DELIVERY, RETENTION AND EVIDENCE

4.1 Delivery. Executed Documents shall be delivered to the recipient(s) designated in Attachment A. Delivery by electronic transmission or delivery of a PDF or other electronic copy shall be deemed delivery of an executed original unless the recipient expressly requests an original physical signature.

4.2 Retention. Each Party shall retain records of executed Documents in accordance with its customary record retention policies and for the retention period: . A stored electronic copy of a Document that accurately reproduces the signed Document shall be admissible as evidence of the Document.

5. INDEMNIFICATION

5.1 Indemnity. Each Party (the "Indemnifying Party") shall indemnify, defend and hold harmless the other Party (the "Indemnified Party") from and against any loss, liability, cost or expense (including reasonable attorneys' fees) arising from the Indemnifying Party's breach of any representation, warranty or covenant contained in this Request or arising from an unauthorized execution or misuse of an authorized signature.

6. CONFIDENTIALITY

6.1 Confidential Information. The Parties agree that Documents and any information exchanged in connection with this Request that is designated as confidential or that reasonably should be understood to be confidential shall be held in confidence and used only for purposes of performing obligations under the Documents, except as required by law.

7. NOTICES

Address for Notices to Client:

Address for Notices to Service Provider:

Notices shall be deemed given on the date of delivery if delivered personally or by electronic transmission with confirmation, or three (3) business days after deposit with a recognized national carrier for overnight delivery.

8. AMENDMENT AND WAIVER

No amendment or waiver of any provision of this Request shall be effective unless in writing and signed by both Parties. No failure or delay by either Party in exercising any right shall operate as a waiver of that right.

9. GOVERNING LAW; VENUE

This Request shall be governed by and construed in accordance with the laws of the state of without regard to its conflict of law principles. Each Party consents to the exclusive jurisdiction of the state and federal courts located in that state for disputes arising under this Request.

10. ENTIRE AGREEMENT

This Request, together with Attachment A (Documents) and any other documents expressly incorporated herein, constitutes the entire agreement between the Parties with respect to its subject matter and supersedes all prior agreements and understandings relating thereto.

11. SEVERABILITY

If any provision of this Request is held to be invalid or unenforceable, the remaining provisions shall continue in full force and effect and shall be construed so as to effectuate the intent of the Parties as nearly as possible.

12. COUNTERPARTS

This Request may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument. A copy or facsimile of a signature shall be deemed an original signature for all purposes.

ATTACHMENT A — DOCUMENTS

List of Documents to be executed pursuant to this Request (describe each document, the party responsible for execution, and any required witnesses or notarial acts).

ADDITIONAL ROUTING / INSTRUCTIONS

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