Service Withdrawal Affidavit

SERVICE WITHDRAWAL AFFIDAVIT

Affiant Name:

Service Provider Name:

Contract or Account No.:

Effective Withdrawal Date:

WHEREAS

WHEREAS, the Affiant entered into a written or oral arrangement for services described herein with the Service Provider on or about ; and

WHEREAS, the Affiant seeks to withdraw, suspend, or terminate certain services identified below and to document the parties' mutual acknowledgments, payment obligations, and the effective date of withdrawal; and

WHEREAS, the Service Provider is willing to accept the withdrawal on the terms and conditions set forth in this affidavit and to cooperate in the orderly cessation or transfer of the affected services.

AFFIDAVIT OF WITHDRAWAL

The Affiant hereby certifies under penalty of perjury that the information contained in this affidavit is true and correct to the best of the Affiant's knowledge. The Affiant withdraws the following services, subscriptions, accounts, or engagements from the Service Provider, effective as of the Effective Withdrawal Date:

SCOPE OF WORK

The parties acknowledge and agree that the Scope of Work to be concluded, transferred, or discontinued in connection with this withdrawal is limited to the items described below. Any work, services, deliverables, or obligations not expressly listed below shall continue subject to the underlying agreement unless otherwise modified in writing.

PAYMENT TERMS

The parties agree the final accounting and any amounts owed in connection with the withdrawal shall be resolved as follows.

Unless otherwise stated above, any outstanding sums shall be due and payable within days of the Effective Withdrawal Date. The Service Provider may set off amounts owed against outstanding obligations and may retain possession of property until full settlement as permitted by law.

TERM AND TERMINATION

This withdrawal becomes effective on the Effective Withdrawal Date identified above and continues until all transitional obligations described in the Scope of Work and Payment Terms are satisfied or until the End Date set forth below, unless earlier terminated in accordance with this affidavit.

Either party may terminate any continuing obligations under this withdrawal upon written notice to the other party given at least the number of days set forth above, except that termination shall not relieve either party of obligations accrued prior to termination, including payment obligations, confidentiality obligations, and duties to return property.

CONFIDENTIALITY

Both parties agree that any proprietary, confidential, or trade secret information disclosed in connection with the services, the withdrawal, or the settlement shall remain confidential and shall not be disclosed to third parties except as required by law or with the prior written consent of the disclosing party. Confidential information does not include information that is or becomes publicly available through no breach of this affidavit.

GOVERNING LAW

This affidavit and any dispute arising out of or relating to it 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 affidavit constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations, and understandings, whether written or oral, relating to the withdrawal of services, except to the extent expressly preserved in writing and signed by both parties.

CERTIFICATION

The Affiant affirms under penalty of perjury that the statements made in this affidavit are true and correct and that the Affiant is authorized to execute this affidavit on the Affiant's own behalf and, if applicable, on behalf of any entity identified above.

The parties confirm that any attachments, exhibits, or schedules referenced herein form part of this affidavit and shall be incorporated by reference as if fully set forth.

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