1. PURPOSE OF AGREEMENT

By signing this Agreement, you:

• Affirm that you are either (a) the individual responsible for paying the bill or expense, or (b) someone authorized by that individual to create a campaign on their behalf;
• Grant EverGrace Financial LLC permission to:
• Review and verify submitted documentation (e.g., bills, invoices, quotes, estimates, legal fees, funeral costs, disaster-related repairs, etc.);
• Communicate with third parties as needed to validate the legitimacy of the expense;
• Approve or reject campaigns at its sole discretion based on accuracy, completeness, or suspicion of fraud;
• Request additional documentation or clarification at any time;
• Remove or cancel campaigns if they are found to contain inaccurate, unverifiable, or misleading information;
• Refund donors if a campaign is canceled or found to be in violation of platform guidelines.

Initial here: Initial here

2. DOCUMENTATION VERIFICATION & COMMUNICATION CONSENT

You authorize EverGrace Financial LLC to contact and communicate with:

• Vendors, service providers, landlords, legal offices, government agencies, or other third parties relevant to the billed expense.

We may request and confirm:

• The validity of the document(s) you submit;
• Outstanding amounts, payment deadlines, or service terms;
• That you are either the responsible party or are acting with permission from the responsible party.

You acknowledge that campaigns are not published or active until EverGrace completes its verification process. Until that time, campaigns remain in a pending status and may be edited, paused, or deleted.

Initial here: Initial here

3. NO FUND TRANSFER TO USER

Funds raised through EverGrace are held in escrow and will be paid directly to verified third parties (e.g., vendors, landlords, service providers, attorneys, etc.) on your behalf.

You will not receive funds personally or into a personal account, and you waive any right to receive contributions directly.

Initial here: Initial here

4. MISREPRESENTATION & LIABILITY

If you submit false, misleading, or unauthorized information, or impersonate another individual without permission, you accept full legal and financial liability. You agree to indemnify and hold harmless EverGrace Financial LLC, its agents, directors, officers, and affiliates from any claims arising out of:

• Your misuse of the platform;
• Fraudulent campaigns;
• Unauthorized fundraising on behalf of another person or entity;
• Submission of falsified or altered documents.

EverGrace reserves the right to pursue legal action if fraud is suspected or proven.

Initial here: Initial here

5. PRIVACY, PUBLICITY & SHARING

You may designate your campaign as private or public. If public, you consent to the distribution of your campaign via email, social media, and third-party platforms.

You may request edits or deletion of your campaign only through the platform's approved user dashboard. EverGrace reserves the right to retain campaign information for compliance, audit, and fraud prevention purposes.

Initial here: Initial here

SIGNATURE PAGE

User / Responsible Party Full Name:

Email:

Phone Number:

Signature of User or Authorized Representative:

Date: 01/15/2026

Initial here to confirm that you have reviewed and agree to all pages of this Agreement: Initial here

1. PURPOSE OF AGREEMENT

By signing this Agreement, you:

• Affirm that you are either (a) the individual responsible for paying the medical bills or (b) someone authorized by that individual to create a campaign on their behalf.
• Grant EverGrace Financial LLC full permission to:
• Verify your submitted bills with providers and institutions;
• Collect and disclose health information;
• Pay medical bills directly to providers using funds raised;
• Reject or remove any fundraiser based on unverifiable, inaccurate, incomplete, or suspicious information;
• Request additional documentation at any time;
• Cancel campaigns prior to or during fundraising at our sole discretion;
• Return funds to donors if a campaign is canceled or rejected.

Initial here: Initial here

2. DISCLOSURE & VERIFICATION CONSENT

You authorize EverGrace Financial LLC to contact and communicate with:

• Medical providers (including hospitals, clinics, individual practitioners);
• Billing departments;
• Insurance providers;
• Payment processors or third parties involved in the billing process.

EverGrace will request and confirm the following:

• Your identity and relationship to the bill;
• Account numbers, invoice amounts, billing dates, and due amounts;
• Medical conditions associated with the bill (where applicable);
• Any supporting documentation necessary for validation.

You acknowledge that campaigns are not approved until EverGrace completes this verification process and explicitly publishes your fundraiser. Until such time, campaigns remain pending and may be edited, rejected, or deleted at our discretion.

Initial here: Initial here

3. NO FUND TRANSFER TO USER

All funds raised via EverGrace are held in escrow and will be paid directly to verified service providers on your behalf. You will not receive funds into a personal account, and you waive any claim to direct receipt of donor contributions.

Initial here: Initial here

4. MISREPRESENTATION & LIABILITY

If you submit information about another person without their consent, or submit fraudulent, misleading, or inaccurate information, you accept full liability for damages, including legal and criminal consequences. You also agree to indemnify and hold harmless EverGrace Financial LLC, its employees, directors, agents, and affiliates.

EverGrace is not liable for:

• Inaccuracies in submitted documentation;
• Delays in verification;
• Campaigns created without valid third-party authorization.

Initial here: Initial here

5. PRIVACY, PUBLICITY & SHARING

You control whether your campaign profile is private or public. If public, you consent to the sharing of your campaign by other users across social platforms. You may modify, request deletion, or make other account changes only through EverGrace’s approved platform processes.

Initial here: Initial here

6. HIPAA AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION

This section complies with the Health Insurance Portability and Accountability Act (HIPAA), and authorizes EverGrace Financial LLC to verify medical bills and conditions related to your campaign.

Authorization to Disclose Health Information under HIPAA

By signing below, I authorize the use and disclosure of my protected health information as described below:

Patient Name:

Date of Birth:

Name of Healthcare Provider/Hospital/Facility Authorized to Disclose Information:

Name of Person or Entity Authorized to Receive Information: EverGrace Financial LLC

Description of Information to be Disclosed: Medical records, billing statements, diagnosis and treatment records related to the condition for which funds are being raised, including insurance claim history and balances due.

Purpose of Disclosure: To verify the legitimacy of the fundraiser and associated bills.

Expiration Date or Event: One (1) year from the date signed below, or upon written revocation.

Patient Rights:

• I understand that I may revoke this authorization at any time in writing.
• I understand that treatment, payment, enrollment, or eligibility for benefits is not conditioned on signing this form.
• I understand that information disclosed may be subject to redisclosure by EverGrace Financial LLC and may no longer be protected by HIPAA.
• I understand that I may request a copy of this signed Authorization.

Initial here: Initial here

SIGNATURE PAGE

Patient / User Full Name:

Email:

Phone Number:

Signature of Patient or Authorized Representative:

Date: 15/01/2026

X I affirm that I am the patient.

X I affirm that I am the authorized representative of the patient and have permission to submit this fundraiser.

Initial here to confirm that you have reviewed and agree to all pages of this Agreement: