Client agrees by filling out this form you will be asked to provide personal information including his/her name, email address and a contact phone number. Client agrees to allow Company access to this personal information for all lawful purposes. Client is responsible for the accuracy of the identifying information, maintaining the safety and security of his/her identifying information, and updating Company on any changes to his/her identifying information. The information provided to Company by Client will be kept secure and is subject to the same confidentiality and accuracy requirements as Client’s identifying information indicated above.