Signature Application Form

Signature Application Form

Recitals

WHEREAS, Applicant Name: (the "Applicant") seeks formal recognition and registration of a signature specimen and associated signature authority for use in business transactions and records; and

WHEREAS, Issuing Organization: (the "Organization") requires a completed Signature Application Form and related certifications for acceptance of such signature specimen and for authorization of signature use;

NOW, THEREFORE, in consideration of the mutual promises contained herein and other good and valuable consideration, the parties submit this Signature Application Form to document the requested authorization, certification, and obligations regarding the specimen signature and signature authority.

Scope of Work

The Applicant requests that the Organization accept and register the specimen signature and authorize its use as set forth below. The precise scope of permitted signature use, limitations, and any delegated authorities will be documented in the field below and become binding upon acceptance by the Organization.

Payment Terms

Applicant shall pay the Organization fees for processing, verification, and ongoing maintenance as provided below. Fees are non-refundable unless expressly stated in writing by the Organization.

Late payments shall incur interest at a rate of on the outstanding balance, calculated monthly and compounded as permitted by applicable law. Applicant agrees to reimburse the Organization for reasonable collection costs including attorney fees if applicable.

Term and Termination

This application and any authorization granted pursuant to acceptance of this application shall commence on Start Date: and shall continue until End Date: , unless earlier terminated in accordance with this section.

Either party may terminate the authorization for cause upon written notice given not less than Notice Period (days): . Termination for convenience by either party requires thirty (30) days' prior written notice unless otherwise agreed in writing.

Confidentiality

Applicant and Organization each acknowledge that information provided in connection with this application, including specimen signatures, identity documentation, and security procedures, constitute Confidential Information. Each party shall maintain Confidential Information in strict confidence and shall not disclose such information except to those employees, agents, or contractors who have a legitimate need to know and who are bound by confidentiality obligations at least as restrictive as those contained herein.

The obligations of confidentiality shall survive termination of any authorization granted hereunder for a period of five (5) years or as otherwise required by applicable law.

I certify that I will maintain Confidential Information in accordance with the terms above.

Governing Law

This Signature Application Form and any authorization or agreement arising from it shall be governed by and construed in accordance with the laws of the State of without regard to choice-of-law rules. Venue for any dispute arising under this Form shall lie exclusively in the state or federal courts located in the same state unless otherwise agreed in writing.

Entire Agreement

This Form, together with any attachments, exhibits, or written acceptance executed by the Organization, constitutes the entire agreement between the Applicant and the Organization with respect to the matters set forth herein and supersedes all prior or contemporaneous understandings and agreements, whether written or oral.

Applicant Information

Identification and Verification

Specimen Signature

Provide up to three specimen signatures below as they are to appear in authorized documents. Print name exactly as it should appear next to the signature.

Certification and Acknowledgement

The Applicant certifies under penalty of perjury that the information provided in this Signature Application Form is true, complete, and correct to the best of Applicant's knowledge. Applicant authorizes the Organization to verify identity through third-party sources where permitted and to retain copies of identification documents to support the application.

I certify that the specimen signatures submitted are genuine, that I am the person identified in this application, and that I have the authority to request the signature authorization described herein.

Applicant further agrees to promptly notify the Organization in writing of any change in circumstances that affects the validity of any information or specimen provided, including but not limited to name changes, revocation of authority, or changes in employment or title.

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