Supplemental Business Status

SUPPLEMENTAL BUSINESS STATUS

Business Identification

LLC Corporation Sole Proprietor Partnership Other:

WHEREAS Recitals

WHEREAS, the entity identified as (the "Business") has previously provided business status information to the Reporting Entity and seeks to supplement and amend that information as set forth herein;

WHEREAS, the Business is reporting one or more changes in its corporate status, ownership, tax classification, principal place of business, or other material facts effective as of (the "Effective Date"); and

WHEREAS, the Reporting Entity requires a written supplemental statement to update its records and to establish the parties' mutual understanding of the Business's current status and obligations.

Nature of Supplemental Change

Please indicate the reason(s) for this supplemental filing (check all that apply):

Change of Ownership/Control Change of Address Change of Tax Classification Change of Legal Name

Scope of Work

The Reporting Entity will receive, review, and record the supplemental information provided by the Business for the limited purpose of updating its internal records, filings, and communications. The Business will provide all supporting documentation reasonably necessary to verify the supplemental information.

Payment Terms

In consideration for the Reporting Entity's review and administrative processing of this Supplemental Business Status, the Business agrees to pay the fees set forth below.

All fees are non-refundable except as expressly provided in a written amendment signed by both parties. If the Business fails to pay any undisputed amount when due, the Reporting Entity may suspend processing until payment is received.

Term and Termination

This Supplemental Business Status shall become effective on and shall continue until unless earlier terminated pursuant to this Section.

Either party may terminate this Supplemental Business Status for convenience upon days' prior written notice. Termination shall not relieve either party of obligations incurred prior to the effective date of termination, including payment for services rendered and confidentiality obligations.

Confidentiality

The parties acknowledge that certain information exchanged pursuant to this Supplemental Business Status may be confidential. Each party agrees to keep Confidential Information in strict confidence and to use such information solely for the purposes of implementing and maintaining the records described herein. Confidential Information does not include information that is or becomes generally available to the public through no fault of the receiving party, or information lawfully received from a third party without breach of an obligation of confidentiality.

A receiving party may disclose Confidential Information to the extent required by law or valid legal process, provided that, where permitted, the receiving party provides prompt written notice to the disclosing party and cooperates reasonably to limit the scope of such disclosure.

Representations and Warranties

The Business represents and warrants that the supplemental information provided herein is true, complete, and accurate in all material respects as of the Effective Date, and that the person executing this Supplemental Business Status on behalf of the Business is duly authorized to do so.

Governing Law

This Supplemental Business Status 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 Supplemental Business Status, together with any attached exhibits or schedules and the original business status documentation expressly incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral.

Execution and Certification

By signing below, the undersigned certify that they are authorized representatives of their respective parties and that the information contained in this Supplemental Business Status is true and accurate to the best of their knowledge. The parties agree that electronic signatures or facsimile signatures shall be treated as original signatures for all purposes.

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