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WORK ORDER AGREEMENT

by and between

Maryland Information Division of NICUA! In"#

and t$e

[INSERT NAME OF STATE AGENCY]

[Work Order Agreement Title & Reference !O]

T%I WORK ORDER AGREEMENT"t#e $WO Agreement% i' m(de (nd entered into t#i'

)))))))) d(* of )))))))))))+ ,-))+ .* (nd .et/een [INSERT NAME OF STATE AGENCY]

"$Agenc*% (nd NIC0SA+ Inc1 "$NIC0SA%1

ANY !AYMENT !ROCESSING SER2ICES !RO2I3E3 !0RS0ANT TO T4IS WO

AGREEMENT S4A55 E 3EEME3 TO E $E5ECTRONIC SER2ICES% AS SET FORT4

IN SECTION 61718 OF T4E CONTRACT1 A55 OT4ER !RO30CTS AN3 SER2ICES

!RO2I3E3 0N3ER T4IS WO AGREEMENT S4A55 E 3EEME3 TO E $C0STOMMANAGE3 SO50TIONS% AS SET FORT4 IN SECTION 6171, OF T4E CONTRACT1

T#i' WO Agreement i' .('ed 9:on t#e follo/ing :remi'e';

[3ESCRIE 4ERE]

NOW THEREFORE+ in con'ider(tion of t#e m9t9(l condition'+ co

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E1 !ort(l Fee' = '#(ll #(

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diligentl* to (ccom:li'# e(c# '9c# (::lic(tion (ccording to t#e 'c#ed9le in (ccord(nce

/it# t#e rel(ti

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@1 It i' 9nder'tood (nd (greed t#(t NIC0SA '#(ll re':ond to (nd+ if re9e'ted+ (::e(r

.efore (n* (nd (ll legi'l(ti

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ECTION 4' Noti"es#

81 NIC0SA (nd t#e Agenc* re:re'ent t#(t t#e* /ill immedi(tel* notif* t#e ot#er' of (n*

t#ird :(rt* (ction' .ro9g#t (g(in't (n* of t#em t#(t in

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IN WITNESS TO THEIR AGREEMENT TO ALL THE ABOVE AND FOREGOING,t#e

:(rtie' #ereto #(