Miscellaneous MPP Request

MISCELLANEOUS MPP REQUEST AND AGREEMENT

Administrative Information

Request ID:    Date of Request:

Recitals

WHEREAS, Client Name: seeks to establish a managed payment plan and requests services related to the Managed Payment Plan ("MPP") described herein; and

WHEREAS, Service Provider Name: has the expertise and capacity to administer, manage, or provide the MPP services under the terms and conditions of this Agreement; and

NOW, THEREFORE, in consideration of the mutual covenants set forth below, the parties agree as follows.

Scope of Work

The Provider shall perform the services necessary to establish and administer the requested Managed Payment Plan. The services shall include enrollment processing, payment scheduling, account reconciliation, notices to Client, and any additional services expressly described in the scope below.

Payment Terms

Amount Due under this request: USD.

Payment Schedule: One-time payment Installments    If installments, number of installments:

Late Payment Fee: . Late fees shall accrue on overdue amounts beginning the day after the due date. The parties acknowledge and agree that this fee is intended as a reasonable estimate of damages.

Payment Method(s):

Term and Termination

Effective Date: .    Term Start Date: .    Term End Date: .

Either party may terminate for convenience upon written notice to the other party delivered at least days prior to the effective termination date. Termination for cause (material breach) may be immediate if the breaching party fails to cure within a commercially reasonable cure period where required by the non-breaching party's notice.

Upon termination, Client shall pay Provider for services performed and documented expenses incurred through the effective termination date, subject to agreed offsets for undelivered work.

Confidentiality

Definitions: "Confidential Information" means non-public information disclosed by either party that is designated confidential or that a reasonable person would understand to be confidential given the nature of the information and the circumstances of disclosure. Confidential Information does not include information that (i) is or becomes publicly known through no breach of this Agreement, (ii) is rightfully received from a third party without restriction, (iii) is independently developed without reference to Confidential Information, or (iv) is required to be disclosed by law or valid process.

Obligations: Each party shall maintain the other party's Confidential Information in confidence using at least the same degree of care it uses to protect its own confidential information, and shall not use Confidential Information except to perform its obligations under this Agreement. The receiving party shall limit disclosure to personnel with a need to know and who are bound to confidentiality obligations.

Duration: The confidentiality obligations under this Agreement shall survive termination for a period of years, provided that trade secrets remain protected for so long as they meet the applicable legal standard for trade secret protection.

Miscellaneous Provisions

Assignment: Neither party may assign its rights or delegate its duties under this Agreement without the prior written consent of the other, except that either party may assign to an affiliate or in connection with a merger, sale of substantially all assets, or other corporate reorganization.

Amendment: Any amendment to this Agreement must be in writing and signed by authorized representatives of both parties.

Governing Law; Entire Agreement

Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to conflict of laws principles.

Entire Agreement: This Agreement, including any attached exhibits or authorized written statements of work, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements, understandings, and communications, whether written or oral, relating to the same subject matter.

Acknowledgment

The individuals signing below represent and warrant that they are duly authorized to execute this Agreement on behalf of the party for which they sign, and that the party agrees to be bound by the terms herein.

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