Hearing Asset Advisors -

HAA Business Relationship Form

Name(Required)

First Last

Title(Required)

Practice Name(Required)

Practice Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have additional bill to and/or ship to addresses?(Required)

Yes

Address 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address 2

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address 3

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address 4

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Add the following accounts(Required)

Resound

Signia

Widex

Widex Account Number

Signia Account Number

Resound Account Number

Hearing Asset Advisors LLC Manufacturer Release Form

I, _____________________________, a principal agent of the business listed below, conducting business at the address(es) listed below, do hereby indicate that I am entering into a business relationship with Hearing Asset Advisors LLC. I authorize my purchasing account to reflect the pricing agreements set forth by Hearing Asset Advisors LLC and for my purchases from the date reflected on this document forward to be considered part of Hearing Asset Advisors group purchasing agreement with companies with whom they have a business relationship.

Date(Required)

Hearing Asset Advisors LLC Relationship Agreement Form

This Memorandum of Understanding (“MoU”) is entered into by and between Hearing Asset Advisors, a Washington Limited Liability Company (“Hearing Asset Advisors”), and __________________________ (“Associate”).

1. Purpose

This MoU outlines the terms of an at-will business relationship between Hearing Asset Advisors and the Associate. The relationship includes access to business advisory services and participation in group purchasing arrangements, both of which are intended to provide strategic value to the Associate’s practice while supporting the operational goals of Hearing Asset Advisors.

2. Background

Hearing Asset Advisors manages a network of leading hearing care providers.
The Associate is an independent provider within this industry.
Both parties intend to collaborate in good faith to pursue business efficiency, patient care improvements, and shared access to resources.
Hearing Asset Advisors may also negotiate vendor relationships that benefit all participants in the network.

3. Statement of Intent

I, ___________________________, a principal agent of the business listed below, hereby acknowledge my intent to enter into this professional relationship with Hearing Asset Advisors LLC. This relationship is at-will and may be terminated at any time by either party with 30 days’ written notice.

I understand that:

Hearing Asset Advisors facilitates group purchasing relationships that offer discounted pricing and may also help support the advisory services it provides.
I may opt out of any group purchasing opportunity by giving written notice to Hearing Asset Advisors.
While most services are funded by group purchasing arrangements, certain services may be offered on a fee basis. In such cases, a written quote and project scope will be provided and agreed to by both parties prior to the start of any work.
Unless otherwise agreed in writing, I am responsible for any hard costs related to services that I request and approve.
All business support services are available at my discretion; I am under no obligation to participate. However, I understand that if I decline any offered service, I cannot hold Hearing Asset Advisors responsible for any business outcomes that may have been influenced by that decision.

4. Product Access and Use

Associate will have the opportunity to purchase products and equipment from Hearing Asset Advisors’ affiliated manufacturers at negotiated group pricing. Such access will be enabled upon completion of the required Manufacturer’s Release Form. The Associate is not obligated to purchase a minimum volume but agrees to work in good faith with the manufacturers, receive product education, and use those products when, in their sole clinical judgment, they are in the patient’s best interest. All recommended services and product uses are to be consistent with medical necessity standards.

5. Consulting and Business Support

Upon request, Hearing Asset Advisors may offer a range of business services, including marketing assistance, human resources consultation, financial performance review, technology systems guidance, and professional development opportunities. Participation in any service is entirely optional and based on the Associate’s needs. Hearing Asset Advisors does not guarantee outcomes and assumes no responsibility for the Associate’s business performance, even if services are utilized.

6. Termination

This MoU remains in effect until terminated. Either party may withdraw from the relationship at any time, with or without cause, by providing 30 days' written notice to the other party.

7. Confidentiality

If a Mutual Non-Disclosure Agreement (“NDA”) has been executed, it will remain in effect and is incorporated into this MoU by reference (Exhibit B). The confidentiality obligations within that NDA will survive the termination of this agreement. Likewise, if a Business Associate Agreement has been executed, it shall be incorporated as Exhibit C.

Date(Required)

Digital Signature(Required)