# Aethelis Order Form

**DRAFT — FOR LEGAL REVIEW**

## Customer

Legal name:

Address:

Primary business contact:

Billing contact:

## Aethelis

Contracting entity:

Address:

Primary contact:

## Engagement

Engagement type:
- Design partner
- Pilot / evaluation
- Commercial deployment

Start date:

End date / subscription term:

## Authorized scope

Organization:

Authorized use case:

Environment:

Authorized users or user limit:

Expected data categories:

Excluded or prohibited data:

## Services

Aethelis services included:

Optional services:

Support scope:

## Commercial terms

Fees:

Billing frequency:

Payment terms:

Approved expenses, if applicable:

Taxes:

## Evaluation success criteria

Complete for pilot/evaluation engagements.

Objective:

Measurements:

Evidence to be reviewed:

Review date:

Decision process following evaluation:

## Security and data requirements

Applicable security requirements:

Data Processing Addendum required:
- Yes
- No
- To be determined

Additional approved requirements:

## Special terms

Insert negotiated engagement-specific terms here.

## Incorporated agreements

Identify applicable documents, such as:

- Pilot / Evaluation Agreement; or
- Master Services Agreement;
- Data Processing Addendum, if applicable;
- other expressly incorporated documents.

## Signatures

CUSTOMER

Name:

Title:

Signature:

Date:


AETHELIS

Name:

Title:

Signature:

Date:

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**Legal review required before execution.**