Lodgement Form

LOD GEMENT FORM

Client Name:    Client Contact:

Lodging Agent Name:    Agent Contact:

RECITALS

WHEREAS, the Client desires to deliver certain tangible or intangible property, documents, or materials (collectively, the "Lodged Items") to the Lodging Agent for safekeeping, processing, or temporary custody; and

WHEREAS, the Lodging Agent has facilities and procedures suitable for the receipt, storage, and release of the Lodged Items and is willing to accept lodgement on the terms and conditions set forth in this Lodgement Form;

WHEREAS, the parties wish to record the scope, fees, term, and conditions governing the lodgement and release of the Lodged Items.

SCOPE OF LODGEMENT

PAYMENT TERMS

Lodgement Fee Amount:    Billing Frequency:

Payment Schedule:

Late Payment Fee:    Minimum Late Charge:

Client acknowledges responsibility for all fees incurred in connection with storage, handling, insurance (if procured), and any costs of release pursuant to a lawful demand or order. Fees due and unpaid may be subject to a possessory lien as provided below.

TERM AND TERMINATION

Commencement Date:    Term End Date:

Either party may terminate this Lodgement Form for convenience by delivering written notice to the other party at least days prior to the intended termination date. Termination shall not relieve Client of its obligation to pay all fees accrued for services rendered prior to termination.

In the event of non-payment, the Lodging Agent may, following written notice to Client and the expiration of any applicable cure period, exercise a possessory lien over the Lodged Items and, where permitted by law, sell or otherwise dispose of items to satisfy outstanding charges.

CONFIDENTIALITY

Each party shall maintain in confidence all non-public information received from the other party in connection with this Lodgement Form, whether oral or written, marked or unmarked, and shall not use or disclose such information except (a) as reasonably required to perform obligations under this Lodgement Form; (b) as required by law, regulation, or valid order of a court; or (c) with the prior written consent of the disclosing party. The obligations in this section shall survive termination or expiration of this Lodgement Form for a period of three (3) years, or longer where applicable law requires.

LIABILITY AND INSURANCE

The Lodging Agent shall exercise reasonable care in the custody of the Lodged Items. Except for willful misconduct or gross negligence, the Lodging Agent's liability for loss or damage shall be limited to proven direct damages not to exceed the greater of the actual commercial value of the lost or damaged items at the time of lodgement or three times the fees paid for the particular lodgement service, unless a higher value and additional insurance are mutually agreed in writing prior to lodgement.

GOVERNING LAW

This Lodgement Form shall be governed by and construed in accordance with the laws of the state or jurisdiction of , without regard to conflict of laws principles.

ENTIRE AGREEMENT

This Lodgement Form constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous oral or written agreements, representations, and understandings. Any amendment or modification of this Lodgement Form must be in writing and signed by authorized representatives of both parties.

ADDITIONAL TERMS

By signing below, each party represents and warrants that the individual signing has full authority to bind the party named and that the information provided in this Lodgement Form is true and correct to the best of such party's knowledge.

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