Referral Notification Form

Referral Notification Form and Referral Agreement

Date of Notification:

Parties

Client / Referral Subject

Client Identifier or Account #:

WHEREAS Recitals

WHEREAS, the Referrer named above has identified the prospective client identified in this form and seeks to refer that client to the Recipient for the provision of services; and

WHEREAS, the Recipient is willing to accept the referral under the terms set forth in this Notification and Referral Agreement and to provide services as described in the Scope of Work; and

WHEREAS, the parties desire to set out payment handling, confidentiality, and termination provisions relating to this referral.

Scope of Work

The Recipient will provide the services described below to the referred client. Services include duties, deliverables, timelines, and any limitations. The Referrer does not assume responsibility for the Recipient's performance beyond referral facilitation.

Referral Details & Authorization

Date of Referral:

Consent to share client information obtained: Yes

Special instructions to Recipient:

Payment Terms (Referral Fee)

Referral Fee Amount: $

Or Fee Percentage of client revenue: %

Late Fee for overdue referral payments:

Payment Method:

Term and Termination

Effective Date: Term End Date:

Either party may terminate this referral arrangement for convenience upon written notice to the other party given at least days prior to termination. Termination does not affect obligations to pay referral fees already accrued prior to termination.

Confidentiality

Each party agrees to maintain in confidence all non-public information concerning the other party and the referred client that is disclosed in connection with the referral. Confidential information does not include information that: (a) was already known to the receiving party without restriction at the time of disclosure; (b) becomes publicly known through no act or omission of the receiving party; or (c) is required to be disclosed by law, provided the disclosing party is given prompt written notice and reasonable assistance, at the disclosing party's expense, to seek a protective order or other remedy.

Representations and Acknowledgements

The Referrer represents that, to the best of its knowledge, it has authority to refer the client and has disclosed to the client that a referral may result in a referral fee. The Recipient acknowledges it will notify the client as required by applicable law or professional rules and will provide periodic updates to the Referrer regarding material engagement milestones relevant to payment of the referral fee.

Governing Law; Entire Agreement

This Agreement shall be governed by and construed in accordance with the laws of the state of , without regard to conflict of law principles.

This Referral Notification Form and Referral Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings and arrangements, whether oral or written. Any amendment must be in writing and signed by both parties.

Acceptance by Recipient

The Recipient hereby acknowledges receipt of the referral and accepts the terms of this Referral Agreement by signing below. The Recipient agrees to notify the Referrer within days of first substantive contact with the referred client and to provide status updates regarding fee triggers.

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