Service VOR Request Form

SERVICE VOR REQUEST AGREEMENT

Client Name:   Service Provider Name:

RECITALS

WHEREAS, Client requires a verification of records and related services described herein (the "VOR Services") concerning Client's accounts, service history, billing records and compliance documentation; and

WHEREAS, Service Provider represents that it is qualified and equipped to perform VOR Services and agrees to provide such services under the terms and conditions of this Agreement; and

WHEREAS, the parties desire to set forth the scope, payment, confidentiality and other material terms governing the provision of the VOR Services.

SCOPE OF WORK

Service Provider shall perform the VOR Services in a professional manner consistent with industry standards, including verification of records from identified custodians, collection of supporting documentation, preparation of a written verification report, and delivery of the report by the agreed delivery method below.

LOGISTICS & CONTACTS

Request Reference #:   Requested Delivery Date:

PAYMENT TERMS

Fee Amount (USD):

Late Payment Fee:   All amounts are payable in U.S. dollars unless otherwise agreed in writing.

TERM AND TERMINATION

Agreement Start Date:   Agreement End Date:

Either party may terminate this Agreement for material breach by the other party if the breach remains uncured for days after written notice specifying the breach. Termination does not relieve Client of payment obligations for services performed prior to termination.

CONFIDENTIALITY

Each party acknowledges that during performance of the VOR Services it may receive confidential or proprietary information ("Confidential Information"). The receiving party shall not disclose Confidential Information to third parties except to its employees, agents or subcontractors who have a need to know and who are bound by confidentiality obligations no less protective than those set forth herein. Confidential Information does not include information that is or becomes publicly available through no fault of the receiving party or that is independently developed by the receiving party without access to Confidential Information.

Upon termination or request, Service Provider shall return or destroy Client's Confidential Information and provide certification of such return or destruction within ten (10) business days.

AUTHORIZATION AND COMPLIANCE

Client authorizes Service Provider to contact third-party custodians and to obtain records reasonably necessary to complete the VOR Services. Client represents and warrants that it has authority to request such records and to authorize their release to Service Provider.

By checking this box, Client expressly authorizes Service Provider to obtain and verify records on Client's behalf and to rely on third-party responses as part of the verification process.

GOVERNING LAW; LIMITATION OF LIABILITY

This Agreement will be governed by and construed in accordance with the laws of the jurisdiction identified as: without regard to conflict of laws principles.

Except for claims arising from willful misconduct or gross negligence, each party's aggregate liability arising out of or relating to this Agreement shall not exceed the total fees paid by Client to Service Provider under this Agreement.

ENTIRE AGREEMENT

This Agreement, including any appendices or accepted scopes of work signed by the parties, constitutes the entire agreement between the parties and supersedes all prior negotiations, understandings and agreements relating to the subject matter hereof. No amendment or waiver shall be effective unless in writing and signed by both parties.

CERTIFICATION

By signing below, the undersigned certify that they have the authority to bind their respective party to this Agreement, that the information provided herein is true and correct to the best of their knowledge, and that they accept the terms and conditions contained in this Agreement.

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