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付款人和委托收款人合同PaymentandCollectionAuthorizationAgreementKeyInformationItems:ContractNumberDateofAgreementPayerInformationCollectorInformationAmounttobeCollectedPaymentTermsCollectionPeriodResponsibilitiesoftheCollectorResponsibilitiesofthePayerFeesandChargesDisputeResolutionTerminationConditionsGoverningLawAgreementBodyContractNumberThiscontractisdesignatedasContractNumber:______________________________.DateofAgreementThisAgreementisenteredintoon:______________________________.PayerInformation3.1PayerName:______________________________3.2Address:______________________________3.3ContactNumber:______________________________CollectorInformation4.1CollectorName:______________________________4.2Address:______________________________4.3ContactNumber:______________________________AmounttobeCollectedThetotalamounttobecollectedunderthisagreementisUSD______________________________(inwords:______________________________dollars).PaymentTerms6.1PaymentMethodThepaymentshallbemade[cash/check/banktransfer]asspecifiedtheCollector.6.2PaymentSchedulePaymentsaretobemadeaccordingtothefollowingschedule:InitialPayment:USD______________________________dueon______________________________SubsequentPayments:USD______________________________dueon______________________________andevery______________________________thereafter.CollectionPeriodThecollectionperiodforthisagreementisfrom______________________________to______________________________.ResponsibilitiesoftheCollector8.1CollectionTheCollectorisresponsibleforcollectingtheamountspecifiedinSection5fromthePayeraccordingtothePaymentTermsoutlinedinSection6.8.2ReportingTheCollectorshallprovideregularreportstothePayerdetailingtheamountscollectedandanyoutstandingbalances.ResponsibilitiesofthePayer9.1PaymentThePayeragreestomakepaymentsasperthePaymentTermsinSection6.9.2CooperationThePayeragreestocooperatewiththeCollectorandprovideanynecessaryinformationtofacilitatethecollectionprocess.FeesandCharges10.1CollectionFeesAnyfeesassociatedwiththecollectionprocessshallbebornethePayer.ThetotalcollectionfeeisUSD______________________________(inwords:______________________________dollars).10.2AdditionalChargesAnyadditionalchargesincurredduringthecollectionperiodmustbepreapprovedthePayer.DisputeResolution11.1MediationAnydisputesarisingfromthisagreementshallfirstberesolvedthroughmediation.11.2ArbitrationIfmediationisunsuccessful,thedisputeshallberesolvedthrougharbitrationinaccordancewiththerulesoftherelevantarbitrationassociation.TerminationConditions12.1TerminationPayerThePayermayterminatethisagreementprovidingwrittennoticetotheCollectoratleast______dayspriortotheintendedterminationdate.12.2TerminationCollectorTheCollectormayterminatethisagreementprovidingwrittennoticetothePayeratleast______dayspriortotheintendedterminationdate.GoverningLawThisagreementshallbegovernedandconstruedinaccordancewiththelawsofthestateorcountrywheretheagreementisexecuted.SignaturesPayer:______________________________Signature:_________

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