Fraud Portal Registration Form Please answer all of the questions below and be as specific as possible. Carefully review your responses before submitting the form. Upon submission and acceptance of payment, you will receive an E-mail containing your company's employee code. You should print a copy of this for your records. Please reference this code and your company name in any subsequent contacts with FAZ relating to this matter. Thank you. Company Name* Company Street Address*Number of Employees*Number of Locations*Non-Profit or For-Profit Company*Non-ProfitFor-ProfitPrimary Contact Name*Primary Contact Role*Primary Contact E-mail* Primary Contact Phone Number*Secure - Company CodeNon-Profit Fraud Protection Subscription*Just the subscription - $30.00Add on a Quarterly Report - $45.00The quarterly price for the report is $45. You will be billed $15 per month on top of $30 for the fraud protection subscription.For-Profit Fraud Protection Subscription*Just the subscription - $50.00Add on a Quarterly Report - $65.00The quarterly price for the report is $45. You will be billed $15 per month on top of $50 for the fraud protection subscription.Hidden field: Date for first quarterly reportTotal $0.00 You will be billed this amount monthly.Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Dear Organization: This document (“Agreement”) will outline the terms of the retention of Ferraro, Amodio & Zarecki, CPAs in the above captioned matter. The Agreement addresses the provision of Confidential web based Reporting Portal Services for you and your organization. SERVICES TO BE PROVIDED 1. Ferraro, Amodio & Zarecki, CPAs will provide confidential web based reporting portal access services (“Services) so employees of your organization can report suspected illegal or other serious misconduct within or against their company, co-workers, or vendors. “Employees” of your organization shall be defined as those individuals employed by the organization or who are members, partners, officers or directors of the organization. “Employees” can also include other individuals that you specifically identify as authorized to use the Services. Those employees that utilize the Services shall be deemed “Complainants”. Services will be available on a twenty-four hour a day, seven-day a week basis for the term of this Agreement. If requested by the Complainant, staff will only be available speak with the Complainants from 9AM to 5PM (Eastern Standard Time) on weekdays, excluding holidays that fall on a weekday (New Years Day, Memorial Day, the Fourth of July, Labor Day, Columbus Day, Thanksgiving, the day following Thanksgiving, and Christmas). Complainants are still able to leave their complaints on weekends and anytime using the web based reporting portal. 2. Ferraro, Amodio & Zarecki, CPAs will make its best effort to maintain the anonymity of Complainants, if so requested and to the extent permitted by law. 3. Ferraro, Amodio & Zarecki, CPAs will maintain the necessary security of the web based reporting portal to the extent that it is within its control to reasonably protect the identity of anonymous Complainants and confidentiality of the information (“Complaint”) provided. 4. Ferraro, Amodio & Zarecki, CPAs will assign a unique Case Identification Number (“Case ID”) to each web based reporting portal Complaint received. 5. By no later than the end of the next business day following receipt of a web based reporting portal Complaint, Ferraro, Amodio & Zarecki, CPAs will advise, by telephone, a person identified by your organization (“Contact Person”) of the Complaint and provide a verbal summary of such Complaint. Ferraro, Amodio & Zarecki, CPAs will send a written report (“Report”) to the Contact Person, within 10 Days summarizing the specifics of the Complaint and referencing the assigned Case ID. Ferraro, Amodio & Zarecki, CPAs will not provide a Report for complaints which they deem nuisance calls and/or do not involve illegal or other serious misconduct. 6. Ferraro, Amodio & Zarecki, CPAs will make its best effort to encourage follow-up communication from the Complainant. Ferraro, Amodio & Zarecki, CPAs will notify the Contact Person in a similar fashion of any subsequent contacts from the Complainant and reference the Case ID in any such communication. 7. Ferraro, Amodio & Zarecki, CPAs assumes no further responsibility or liability, and will take no further action, concerning Complaints received and forwarded to you unless a separate retainer agreement is executed for these additional services. 8. Ferraro, Amodio & Zarecki, CPAs employees having a material role in the processing of Complaints received and forwarded to you will have no material role in any subsequent Ferraro, Amodio & Zarecki, CPAs services performed resulting from such Complaints, if any. 9. Ferraro, Amodio & Zarecki, CPAs, if requested by you, will provide to the Contact Person a quarterly report summarizing the number of Complaints received by reporting method and Complaint type (i.e. conflicts of interest, financial fraud, abuse of resources, harassment/discrimination, time and attendance abuse) to assist you in identifying patterns or trends that might require management’s attention. The cost of this service is an additional $50 per quarter. 10. Ferraro, Amodio & Zarecki, CPAs will provide your organization with posters reflecting the web based reporting portal address to be prominently displayed in lobbies, lunch rooms and other public areas. 11. This Agreement is effective for a minimum of 90 days and shall continue automatically unless terminated earlier in accordance with this Agreement. Ferraro, Amodio & Zarecki, CPAs will have the right to adjust the Quarterly Report Fees or any other costs annually beginning January 1, 2019. DOCUMENT AND INFORMATION NEEDS We are in receipt of information from you that will enable us to begin planning and implementation of these services and a request for additional information may follow under separate cover, once retained. Activities may include periodic teleconferences and/or other communications with the contact person or other designated representative(s) to discuss these Services. By signing this Agreement, upon request by our office, you agree to provide us promptly, all information and documentation of which you have knowledge or in your possession that we deem necessary in connection with furnishing these Services. You additionally represent and warrant that all information and documentation provided or to be provided by you is true, correct and complete to the best of your knowledge and belief. LIMITING CONDITIONS Our fees and your unconditional obligation for payment are not in any way contingent on the information received by Ferraro, Amodio & Zarecki, CPAs and forwarded to you, or the results of an ultimate settlement or decision in an administrative proceeding or a court of law regarding such information. Ferraro, Amodio & Zarecki, CPAs will maintain the availability of web based reporting portal services except for interruptions caused by circumstances beyond its reasonable control, including but not limited to Internet or electric power failures, fires, explosions, acts of God, labor disputes, war, revolution, civil unrest or governmental action not the fault of Ferraro, Amodio & Zarecki, CPAs. Ferraro, Amodio & Zarecki, CPAs makes no warranties, expressed or implied, and assumes no legal liability or responsibility for the accuracy, veracity, completeness, or usefulness of any information received by Ferraro, Amodio & Zarecki, CPAs and forwarded to you. Further, Ferraro, Amodio & Zarecki, CPAs assumes no liability as a result of the use or misuse of the information provided to you. Your organization and your employees, its heirs, successors, and agents, agree to indemnify and hold harmless Ferraro, Amodio & Zarecki, CPAs , its, partners, directors, officers, employees, and agents with respect to any and all claims, liens, losses, damages, liabilities, judgments, or settlements, including attorneys’ fees, costs and other expenses incurred by Ferraro, Amodio & Zarecki, CPAs as a direct and proximate result of your organization or your employees’ deliberate act(s), as well as any negligent act(s) or omission(s) of your organization or any of its successors, assigns, employee(s), agent(s), or related entity(ies), arising out of the Services and/or this Agreement and/or any violation(s) of federal, state or local statutes, regulations or ordinances. Your organization agrees to promptly notify Ferraro, Amodio & Zarecki, CPAs in writing upon your receipt of notice of any claims or legal action arising out of or in connection with the Services and/or this Agreement. The rights and responsibilities established in this paragraph shall survive the termination of this Agreement, regardless of the reason for such termination. All documents created by us and not forwarded to you will remain the property of Ferraro, Amodio & Zarecki, CPAs. We will be liable only to produce or return those materials and documents supplied to us by you while performing these Services upon your written request, and we reserve the right to retain copies of documents that, in our opinion, are necessary to complete our file. Any documents, records or other proprietary information developed by Ferraro, Amodio & Zarecki, CPAs during the performance of these Services will only be produced in response to court order, subpoena or when requested at trial. By executing this Agreement, you acknowledge that Ferraro, Amodio & Zarecki, CPAs will maintain all records generated as a result of any Services rendered, including, but not limited to, correspondence, records and other documents, for a period of five (5) years from the last date of our involvement in the matter as determined by reference to our billing records. Such maintenance may involve the conversion of hard copy documents to scanned files. Should circumstances require or you desire to maintain your other records longer than five (5) years, we suggest that you retain copies of all documents produced. APPROACH TO SERVICE Our offices will employ a client service team in providing all Services under this Agreement. In accordance with this approach, professionals at varying training and experience levels will be utilized while performing these Services and will be assigned specific tasks and/or aspects of these Services based upon nature and complexity. BILLING TERMS Service Fees – You will be billed $50/month for Profit Organizations - strictly for the fraud portal and reporting, does not include any remediation work or $30/month - Non-Profit Organizations - strictly for the fraud portal and reporting, does not include any remediation work. Quarterly Reports Fee – If requested, you will be billed $50 for each Quarterly Report prepared and forwarded to you. The Quarterly Report will provide detail of your fraud portal activity. All billings will be billed periodically and payment for the services will be made via the web payment process. Please carefully review all charges. If you believe any billings to be in error or have any objections, you should notify our office in writing immediately. If we do not receive such written notice of error or objection within fifteen (15) days of the date of the charge, the billing will be deemed final, fair and accurate in all respects and will not be subject to future modification. Our billings, and your unconditional requirement to pay them, are not in any way contingent on subsequent resolution of Reports forwarded to you. You have the unconditional right to terminate our Services immediately after the initial 90 days upon written notice. In that event, any unbilled fees will be billed and will become immediately due and payable. We reserve the right to discontinue Services if billings are not paid within 30 days of being rendered. If any outstanding bills regarding this matter are turned over to a third party for collection, it is agreed that all costs related to that action will be your responsibility, including reasonable attorney’s fees. Interest at the rate of 9% per annum will be added to any balance outstanding for more than 30 days. The total liability of Ferraro, Amodio & Zarecki, CPAs including our partners and employees, for any and all claims or counterclaims related to this Agreement, is limited to the total fees paid to us for Services performed under this Agreement. Ferraro, Amodio & Zarecki, CPAs will not have any obligation to forward a Report until your account is current or unless alternative payment arrangements have been mutually agreed to in writing between Ferraro, Amodio & Zarecki, CPAs and you. Ferraro, Amodio & Zarecki, CPAs will have no liability to you, or any other person, by reason of suspension of Services or withdrawal, due to your failure to pay all amounts due Ferraro, Amodio & Zarecki, CPAs. Please also be advised that any Report forwarded to you is limited for use in this matter only and is not intended for any other use. Any such other use without written consent by Ferraro, Amodio & Zarecki, CPAs is strictly prohibited. In the event we are compelled by subpoena, court order or government regulatory agency to appear at any judicial proceeding or to provide documents relative to web based reporting portal services relating to your organization, you agree to reimburse us for all expenses incurred in compliance thereof, as well as compensate us at our current hourly rates in effect at the time and upon the same terms and conditions provided in this Agreement. So as to handle these Services in an organized and time efficient manner, all communications, oral and written, shall be directed in a manner jointly agreed to by you and Ferraro, Amodio & Zarecki, CPAs. This Agreement governed by the laws of New York and any enforcement action(s) that may be necessary due to the breach of this Agreement is subject to venue in Saratoga County, New York. If any provision of this Agreement shall be held by a court of competent jurisdiction to be illegal, invalid or unenforceable, such provision shall have no effect upon and shall not impair the enforceability of any other provision of this Agreement, which shall continue to be and remain in full force and effect. CONFIDENTIALITY Our Services are confidential. The parties acknowledge that, if Services are rendered by Ferraro, Amodio & Zarecki, CPAs, Ferraro, Amodio & Zarecki, CPAs will come into possession of information that may be confidential and sensitive business information, including, but not limited to, financial, payroll, personnel and other human resources type information (the “Confidential Information”). All reasonable steps will be taken to control access or availability of any Confidential Information or other documents and records related to this matter. Confidential Information does not include information that: (i) is in or enters the public domain without breach of this Agreement; (ii) Ferraro, Amodio & Zarecki, CPAs lawfully receives from a third party without restriction on disclosure and without breach of a nondisclosure obligation by the third party; (iii) Ferraro, Amodio & Zarecki, CPAs knew prior to receiving such information from the disclosing party; or (iv) is disclosed by the disclosing party to a third party without a duty of confidentiality. Ferraro, Amodio & Zarecki, CPAs will use the Confidential Information only in the exercise of rights or satisfaction of obligations under this Agreement. Ferraro, Amodio & Zarecki, CPAs may disclose the Confidential Information only to its employees who have a need to know and use such information. Each party shall take all reasonable measures to prevent the unauthorized use, dissemination, or publication of the other’s disclosed Confidential Information, which shall in no event be less than the measures it uses to maintain the confidentiality of its own information of similar importance. Notwithstanding the foregoing, each party may disclose Confidential Information: (i) as required by law; (ii) in response to a subpoena or court order if the party upon whom the subpoena or order is served first attempts to obtain a protective order to prohibit or restrict the disclosure; and (iii) by either party to enforce its rights under this Agreement. In the interest of facilitating the Services under this Agreement, we routinely communicate by facsimile transmission or electronic mail (e-mail) over the Internet. Such communications may include information that is deemed confidential. You consent to the use of facsimile and/or e-mail communications for this matter, and you recognize and accept that we have no control over the unauthorized interception of these communications once they have been sent. Accordingly, we take no responsibility for any unauthorized or unintended interception of these communications or access to them. Your execution of this Agreement will be deemed to constitute your consent to our use of these communication media. CONFLICTS We have determined that we have no known conflicts in providing the Services under this Agreement. ACCEPTANCE AND CLOSING This is a legally binding contract. By agreeing to these terms, you acknowledge that you have read the entire Agreement and understand its terms, and, if found advisable, had the Agreement reviewed by an attorney. You also acknowledge that the undersigned has full authority to execute this Agreement on behalf of your organization. The written representations and terms contained herein constitute the entire Agreement. Any Amendments to this Agreement shall be in writing in a separate document signed by both parties We would like to thank you for this opportunity to be of service. Should the terms of the arrangement be satisfactory, please indicate your understanding and agreement of the terms contained herein by signing the original of this Agreement in the space provided and returning it as soon as possible so that we may commence our Services for your organization. We have also enclosed a copy of the Agreement for your records. Very truly yours, Ferraro, Amodio & Zarecki, CPAs I agree to the terms above*Agree This iframe contains the logic required to handle Ajax powered Gravity Forms.