Vendor Information Collection

VENDOR INFORMATION COLLECTION AND SERVICES AGREEMENT

Document Analysis (record of preparatory review)

Type of document: Combined Vendor Information Collection form and General Business Agreement used to gather vendor administrative, tax, banking, insurance and capability information while establishing the essential commercial terms of a services engagement.

Typical sections included: identifying recitals (WHEREAS), vendor contact and tax data, banking and remittance instructions, insurance acknowledgements, scope of work, payment terms (amount, schedule, late fees), term and termination provisions, confidentiality obligations, governing law, certification of accuracy, and an executed signature block for Company and Vendor.

Parties and signatures: This is a two-party contract. Both the contracting Company and the Vendor must sign and date to validate the agreement and certify the collected vendor data.

Recitals

WHEREAS, Company requires certain goods and/or services and requires Vendor to provide administrative, tax and payment information for account setup and compliance; and

WHEREAS, Vendor represents that it is duly authorized and qualified to provide the goods and/or services as described below and that the information provided herein is true, complete and accurate; and

NOW, THEREFORE, in consideration of the mutual promises contained in this Agreement and for other good and valuable consideration, the parties agree as follows.

Vendor Identification and Contact

Tax and Legal Classification

Please indicate the Vendor's federal tax classification and provide the taxpayer identification number. Vendor certifies that the TIN provided is correct for IRS reporting and withholding purposes.

Tax Classification (check all that apply):

Individual / Sole Proprietor   C Corporation   S Corporation   LLC   Partnership

Banking and Remittance Instructions

Provide remittance details for electronic payments. Company will rely on these instructions to transmit funds; Vendor will promptly notify Company in writing of any changes.

Insurance and Compliance

Vendor shall maintain insurance as required by contract or as otherwise agreed. Indicate current coverage.

Vendor maintains commercial general liability insurance

Capabilities, References and Scope of Work

Scope of Work (Contract Attachment)

Describe the services, deliverables and performance standards to be provided by Vendor. If additional attachments are necessary, reference attachment identifiers below.

Payment Terms

Company shall pay Vendor in accordance with the terms below. All payments are subject to invoice verification. Vendor shall submit invoices to the designated billing contact identified by Company.

Interest on overdue amounts shall accrue at the lesser of (a) % per month, or (b) the maximum rate permitted by applicable law.

Term and Termination

This Agreement commences on the Start Date and continues until the End Date unless earlier terminated in accordance with this section.

Either party may terminate this Agreement for convenience upon written notice to the other party given not less than days prior to the effective termination date. Either party may terminate immediately for material breach that remains uncured after thirty (30) days' written notice.

Confidentiality

Each party shall maintain in confidence all non-public information disclosed by the other party that is designated confidential or that by its nature should reasonably be considered confidential. Confidential information shall not be disclosed except to employees or contractors with a need to know and who are subject to confidentiality obligations at least as protective as those herein. Confidential obligations survive termination for a period of three (3) years, except for trade secrets which remain protected for as long as they qualify as trade secrets.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of the state identified by Company in its internal records, without regard to conflict of laws principles. The parties submit to the exclusive jurisdiction of the courts located in that state for resolution of disputes.

Entire Agreement

This Agreement, together with any referenced attachments and purchase orders, constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes all prior and contemporaneous oral or written agreements, representations and understandings. Any amendment or modification must be in writing and signed by authorized representatives of both parties.

Vendor Certification and Acknowledgment

Vendor certifies that the information provided in this form is true, complete and correct to the best of Vendor's knowledge, and Vendor agrees to notify Company immediately of any material changes. Vendor acknowledges that Company may rely on the information provided for purposes of contract administration, tax reporting and payment processing.

I certify that the information provided on this form is accurate and complete.

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