Prospect Evaluation Survey

PROSPECT EVALUATION SURVEY

This Prospect Evaluation Survey and Engagement Agreement (the Agreement) is made and entered into as of by and between the Evaluation Provider and the Client/Prospect identified below.

WHEREAS

WHEREAS, Evaluation Provider is engaged in the business of performing sales and market prospect evaluations, strategic assessments, and advisory services; and

WHEREAS, Client/Prospect desires to obtain from Evaluation Provider a structured assessment of the prospective opportunity described in this Survey and to memorialize the terms under which such assessment will be performed; and

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

PARTIES AND CONTACT INFORMATION

EVALUATION SUMMARY

Project / Opportunity Name:   Evaluation Date:

SURVEY CRITERIA

Rate each item on a scale of 1 (low) to 5 (high). Provide concise commentary in the accompanying comment boxes.

PAYMENT TERMS

Evaluation Fee Amount:

Late Fee / Interest on Overdue Amounts:

TERM AND TERMINATION

Term Commencement Date:   Term End Date (if any):

CONFIDENTIALITY

Each party acknowledges that during the performance of this Agreement it may receive Confidential Information of the other party. Confidential Information means non-public information disclosed in any form that is designated as confidential or that reasonably should be understood to be confidential given the nature of the information.

The receiving party shall (a) use Confidential Information solely to perform its obligations under this Agreement, (b) restrict disclosure to its employees and agents with a need to know and subject to confidentiality obligations at least as protective as those herein, and (c) not disclose Confidential Information to third parties without prior written consent of the disclosing party, except as required by law.

By checking this box, the undersigned acknowledges and agrees to the Confidentiality obligations set forth above.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to its conflict of laws principles. Venue for any dispute arising under this Agreement shall be the competent state or federal courts located within that state.

ENTIRE AGREEMENT

This Agreement, including all exhibits and survey responses incorporated herein, 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. Any amendment or modification must be in writing and signed by authorized representatives of both parties.

ADDITIONAL REPRESENTATIONS

Evaluation Provider represents that it will perform the evaluation with reasonable care and in a professional manner consistent with industry standards. Client/Prospect represents that it has authority to provide the information in this Survey and to engage Evaluation Provider under the terms set forth herein.

CERTIFICATIONS & SIGNATURES

The undersigned certifies that the information provided in this Prospect Evaluation Survey is true and complete to the best of their knowledge, and that they are authorized to execute this Agreement on behalf of the named party.

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