The undersigned, {Point of Contact Name (First):3.3} {Point of Contact Name (Last):3.6} enters into this service agreement with Faithful Companions (the “Provider”) to provide {Point of Care Name (First):4.3} {Point of Care Name (Last):4.6} (the “Patron”) with non-medical companionship and homecare services. Specific services requested by the Patron include:

{Summary of Services:6}

at the following address:



{Point of Care Address (Street Address):5.1}
{Point of Care Address (Address Line 2):5.2}
{Point of Care Address (City):5.3}, {Point of Care Address (State / Province):5.4} {Point of Care Address (ZIP / Postal Code):5.5}

The Services will be provided at the hourly rate of {Hourly Rate:7}. This rate is subject to change upon 30 days notice from the Provider. Each visit to provide services requires a minimum of 3 hours. Rates for Services are {Overtime/Holiday Rate:14} per hour on designated holidays. Rates for services performed on weekends are {Weekend Rate:13} per hour. Should a patron request one particular caregiver for more than forty (40) hours in one week, the patron agrees to pay the overtime rate of {Overtime/Holiday Rate:14} per hour for the hours exceeding forty (40) hours.

The undersigned authorizes use of the Patron’s automobile for errands and incidental transportation as may be requested by Patron in connection with the Services. Patron has and will maintain valid and adequate automobile insurance for this vehicle during the term of the agreement and insurance shall include coverage for authorized third party drivers of such vehicle. In the event a Provider employee uses his or her own automobile for errands or incidental transportation at the patron’s request there is a charge of .58 cents per mile, in addition to the regular Service charges. Patron agrees to indemnify the Provider and its employees in connection with liability that may arise in connection with automobile usage that is requested and authorized by the Patron.

Services will be billed ahead bi-weekly (every two weeks) based on the estimated Service hours requested and are due on the receipt of invoice. Services exceeding this estimate and mileage charges will be billed on the subsequent billing. Any overages paid will similarly be adjusted on the subsequent billing. The Patron and the Provider have the right to cancel or suspend this Agreement with 24 hours advance notice. Any amount overpaid by the Patron will be gladly refunded. If notice of cancellation of Services is made less than 24 hours before the scheduled start of the Services, then minimum hours as noted above may be billed. The Patron will be responsible for any fees or expenses, including collection and attorney fees, incurred in collecting delinquent amounts owed the Provider under this Agreement. Interest on delinquent balances over 30 days will be charged at a rate of 1.5% per month.

The Patron agrees to pre-pay {Deposit Amount:15} for {Bi-Weekly Hours:16} service hours based on the first bi-weekly service estimate. If this estimate changes for the next billing period, the Patron agrees to contact the Provider before the end of the second week of services. All service invoices will be mailed to the following address:

{Invoice Mailing Address (Street Address):9.1}
{Invoice Mailing Address (Address Line 2):9.2}
{Invoice Mailing Address (City):9.3}, {Invoice Mailing Address (State / Province):9.4} {Point of Care Address (ZIP / Postal Code):5.5}

The undersigned agrees not to hire or employ any Provider employee(s) while this Agreement is in effect and for a period of one (1) year after termination of this Agreement, unless Provider is given prior notice of such agreement and the parties hereto have mutually agreed upon the payment of a referral fee to Provider.

The undersigned understands that the Provider is a non-medical service provider, is not licensed to perform medical services, and shall not be liable for any damages or liabilities except such as caused by the negligent acts or omissions by Provider employees and which result in bodily injury or property damage. The undersigned has read, fully understood, and, by signing below accepts the terms of this Agreement.