UCLA Short Form Services Agreement (SFSA) Intake Form

UCLA Short Form Services Agreement (SFSA) Intake Form

Please review the standard SFSA form by downloading the template HERE.

Rates for all services can be found HERE.

Once your submission is received, you will receive an automated Smartsheet notification within 3-5 business days containing the draft service agreement document.

Client Name*

Name of Business that will receive invoices and issue payment for services

Do you have an existing SFSA with UCLA?*

Select

Are there changes to your business address?*

Select

Business Address*

Street Address

Business Address*

City, State Zip Code

Country*

Are there changes to your billing information?*

Select

Billing Information

Billing Contact Name*

Billing Address*

Street Address

Billing Address*

City, State Zip Code

Billing Email Address*

Signatory Information

Signatory Name*

Representative who will receive the Docusign link to finalize & sign the SFSA

Signatory Phone Number*

Phone

Signatory Email Address*

Signatory Title or Position*

Agreement Start Date*

Agreement End Date*

Term should not exceed 1 year, unless it is a multi-year project.

Total Fee ($)

This is the estimated amount for all services that may be requested within a 12-month period, including any current requests; only the services completed will be invoiced.

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