<PAGE>

                                                                   EXHIBIT 10.12


[Date]

[Name]
[Title]
[Address]

Dear __________:

Equifax PS, Inc. (the "Company") considers the establishment and maintenance of
a sound and vital management to be essential to protecting and enhancing the
best interests of the Company and its shareholders.  In this connection, the
Company recognizes that, as is the case with many publicly held corporations,
the possibility of a change in control exists and that possibility, and the
uncertainty and questions that it may raise among management, may result in the
departure or distraction of management personnel to the detriment of the Company
and its shareholders.  Accordingly, the Board of Directors of the Company has
determined that appropriate steps should be taken to reinforce and encourage the
continued attention and dedication of members of the Company's management,
including yourself, to their assigned duties without distraction in the face of
potentially disturbing circumstances arising from the possibility of a change in
control of the Company.

In order to induce you to remain in its employ, the Company agrees to provide
you the payments and benefits described in this Letter (in lieu of any severance
payments and benefits you would otherwise receive in accordance with the
Company's severance pay practices) if your employment with the Company is
terminated subsequent to a "Change in Control" of the Company (as defined in
paragraph 3) under the circumstances described in paragraph 4.

1.  No Right to Continued Employment.  This Letter does not give you any right
    --------------------------------
to continued employment by the Company or a Subsidiary, and it will not
interfere in any way with the right the Company or a Subsidiary otherwise may
have to terminate your employment at any time.

2.  Term of This Letter. The terms of this Letter will be effective as of
    -------------------
__________, 2001, and, except as otherwise provided in this Letter, will
continue in effect until _____________, 2006; provided that commencing on
January 1, 2002 and each subsequent January 1, the terms of this Letter will be
extended
<PAGE>

automatically so as to remain in effect for five (5) years from that January 1
unless at least sixty (60) days prior to January 1 of a given year, the Company
notifies you that it does not wish to continue this Letter in effect beyond its
then current expiration date; and provided further that if a Change in Control
occurs prior to the expiration of this Letter, this Letter will continue in
effect for three (3) years from the Change in Control.

3.  Change In Control.  No benefits will be payable under this Letter unless
    -----------------
there is a Change in Control and your employment by the Company is terminated
under the circumstances described in paragraph 4 entitling you to benefits.  For
purposes of this Letter, a Change in Control of the Company means the occurrence
of any of the following events during the period in which this Letter remains in
effect:

     3.1  Voting Stock Accumulations.  The accumulation by any Person of
          --------------------------
     Beneficial Ownership of twenty percent (20%) or more of the combined voting
     power of the Company's Voting Stock; provided that for purposes of this
     subparagraph 3.1, a Change in Control will not be deemed to have occurred
     if the accumulation of twenty percent (20%) or more of the voting power of
     the Company's Voting Stock results from any acquisition of Voting Stock (a)
     directly from the Company that is approved by the Incumbent Board, (b) by
     the Company, (c) by any employee benefit plan (or related trust) sponsored
     or maintained by the Company or any Subsidiary, or (d) by any Person
     pursuant to a Business Combination that complies with all of the provisions
     of clauses (a), (b) and (c) of subparagraph 3.2; or

     3.2  Business Combinations.  Consummation of a Business Combination,
          ---------------------
     unless, immediately following that Business Combination, (a) all or
     substantially all of the Persons who were the beneficial owners of Voting
     Stock of the Company immediately prior to that Business Combination
     beneficially own, directly or indirectly, more than sixty-six and two-
     thirds percent (66-2/3%) of the then outstanding shares of common stock and
     the combined voting power of the then outstanding voting securities
     entitled to vote generally in the election of Directors of the entity
     resulting from that Business Combination (including, without limitation, an
     entity that as a result of that transaction owns the Company or all or
     substantially all of the Company's assets either directly or through one or
     more subsidiaries) in substantially the same proportions relative to each
     other as their ownership, immediately prior to that Business Combination,
     of the Voting Stock of the Company, (b) no Person (other than the Company,
     that entity resulting from that Business Combination, or any employee
     benefit plan (or related trust)
<PAGE>

     sponsored or maintained by the Company, any Eighty Percent (80%) Subsidiary
     or that entity resulting from that Business Combination) beneficially owns,
     directly or indirectly, twenty percent (20%) or more of the then
     outstanding shares of common stock of the entity resulting from that
     Business Combination or the combined voting power of the then outstanding
     voting securities entitled to vote generally in the election of directors
     of that entity, and (c) at least a majority of the members of the Board of
     Directors of the entity resulting from that Business Combination were
     members of the Incumbent Board at the time of the execution of the initial
     agreement or of the action of the Board providing for that Business
     Combination; or

     3.3  Sale of Assets.  A sale or other disposition of all or substantially
          --------------
     all of the assets of the Company; or

     3.4  Liquidations or Dissolutions.  Approval by the shareholders of the
          ----------------------------
     Company of a complete liquidation or dissolution of the Company, except
     pursuant to a Business Combination that complies with all of the provisions
     of clauses (a), (b) and (c) of subparagraph 3.2.

For purposes of this paragraph 3, the following definitions will apply:

     "Beneficial Ownership" means beneficial ownership as that term is used in
     Rule 13d-3 promulgated under the Exchange Act.

     "Business Combination" means a reorganization, merger or consolidation of
     the Company.

     "Eighty Percent (80%) Subsidiary" means an entity in which the Company
     directly or indirectly beneficially owns eighty percent (80%) or more of
     the outstanding Voting Stock.

     "Exchange Act" means the Securities Exchange Act of 1934, including
     amendments, or successor statutes of similar intent.

     "Incumbent Board" means a Board of Directors at least a majority of whom
     consist of individuals who either are (a) members of the Company's Board of
     Directors as of the date of this Letter or (b) members who become members
     of the Company's Board of Directors subsequent to the date of this Letter
     whose election, or nomination for election by the Company's shareholders,
     was approved by a vote of at least two-thirds (2/3) of the directors then
<PAGE>

     comprising the Incumbent Board (either by a specific vote or by approval of
     the proxy statement of the Company in which that person is named as a
     nominee for director, without objection to that nomination), but excluding,
     for that purpose, any individual whose initial assumption of office occurs
     as a result of an actual or threatened election contest (within the meaning
     of Rule 14a-11 of the Exchange Act) with respect to the election or removal
     of directors or other actual or threatened solicitation of proxies or
     consents by or on behalf of a Person other than the Board of Directors.

     "Person" means any individual, entity or group (within the meaning of
     Section 13(d)(3) or 14 (d)(2) of the Exchange Act).

     "Voting Stock" means the then outstanding securities of an entity entitled
     to vote generally in the election of members of that entity's Board of
     Directors.

4.  Termination Following Change in Control.  If any of the events described in
    ---------------------------------------
paragraph 3 constituting a Change in Control occurs, you will be entitled to the
payments and benefits provided for in paragraph 5 if your employment is
terminated within six (6) months prior to the Change in Control in connection
with the Change in Control or your employment is terminated within three (3)
years from the date of the Change in Control, unless your termination is (a)
because of your death, (b) by the Company for Cause or Disability, or (c) by you
other than for Good Reason. The payments and benefits provided for in paragraph
5 will be in lieu of any severance payments you would otherwise receive in
accordance with the Company's severance pay practices, but will have no effect
on any of the Company's other employee benefit plans or practices, as amended
from time to time.

     4.1  Cause.  Termination by the Company of your employment for "Cause"
          -----
     means termination by the Company of your employment upon (a) your willful
     and continued failure to substantially perform your duties with the Company
     (other than any failure resulting from your incapacity due to physical or
     mental illness), after a written demand for substantial performance is
     delivered to you by the Chief Executive Officer of the Company (or if you
     are the Chief Executive Officer, the Chairman of the Compensation Committee
     of the Board of Directors) that specifically identifies the manner in which
     the Chief Executive Officer believes that you have not substantially
     performed your duties, or (b) your willfully engaging in misconduct that is
     materially injurious to the Company, monetarily or otherwise.  For purposes
     of this subparagraph 4.1, no act, or failure to act, on your part will be
     considered "willful" unless done, or omitted to be done,
<PAGE>

     by you not in good faith and without reasonable belief that your action or
     omission was in the best interest of the Company. Notwithstanding the
     above, you will not be deemed to have been terminated for Cause unless and
     until you have been given a copy of a Notice of Termination from the Chief
     Executive Officer of the Company (or if you are the Chief Executive
     Officer, the Chairman of the Compensation Committee of the Board of
     Directors), after reasonable notice to you and an opportunity for you,
     together with your counsel, to be heard before (i) the Chief Executive
     Officer, or (ii) if you are an elected officer of the Company, the Board of
     Directors of the Company, finding that in the good faith opinion of the
     Chief Executive Officer, or, in the case of an elected officer, finding
     that in the good faith opinion of two-thirds of the Board of Directors, you
     committed the conduct set forth above in clauses (a) or (b) of this
     subparagraph 4.1, and specifying the particulars of that finding in detail.

     4.2  Disability.  Termination by the Company of your employment for
          ----------
     "Disability" means termination by the Company of your employment following
     and because of your failure to perform your duties as an employee for a
     period of at least one hundred eighty (180) consecutive calendar days as a
     result of total and permanent incapacity due to physical or mental illness
     or injury.  Your incapacity must be certified by a licensed medical doctor
     selected by you.  You will continue to receive your full base salary at the
     rate in effect and any bonus payments under the Plan payable during the one
     hundred eighty (180) day qualification period until termination of your
     employment for Disability.  After that termination, your benefits will be
     determined in accordance with the Company's long-term disability plan then
     in effect and any of the Company's other benefit plans and practices then
     in effect that apply to you.  The Company will have no further obligation
     to you under this Letter and all supplemental benefits will be terminated.
     If the Company disagrees with the certification of your incapacity, it may
     appoint another medical doctor to certify his opinion as to your
     incapacity, and if that doctor does not certify as to your incapacity, then
     the two doctors will appoint a third medical doctor to certify their
     opinion as to your incapacity, and the decision of a majority of the three
     doctors will prevail.  (The Company will bear the costs of the doctors
     opinions.)

     4.3  Good Reason.   Termination by you of your employment for "Good Reason"
          -----------
     means termination by you of your employment based on:

          (a) The assignment to you of duties inconsistent with your position
          and status with the Company as they existed immediately prior to the
<PAGE>

          Change in Control Date (as defined below), or a substantial change in
          your title, offices or authority, or in the nature of your
          responsibilities, as they existed immediately prior to the Change in
          Control Date (or if you receive a promotion or an increase in
          responsibilities or authority after the Change in Control Date, then a
          change with respect to your enhanced position, status,
          responsibilities or authority), except in connection with the
          termination of your employment for Cause or Disability or as a result
          of your death or by you other than for Good Reason;

          (b) A reduction by the Company in your base salary as in effect on the
          date of this Letter or as your salary may be increased from time to
          time;

          (c) A failure by the Company to continue the Company's incentive
          compensation plan(s) ("Incentive Plan"), as it may be modified from
          time to time, substantially in the form in effect immediately prior to
          the Change in Control Date, or a failure by the Company to continue
          you as a participant in the Incentive Plan on at least the basis of
          your participation immediately prior to the Change in Control Date or
          to pay you the amounts that you would be entitled to receive in
          accordance with the Incentive Plan;

          (d) The Company's requiring you to be based more than thirty-five (35)
          miles from the location where you are based immediately prior to the
          Change in Control Date, except for required travel on the Company's
          business to an extent substantially consistent with your business
          travel obligations prior to the Change in Control Date, or if you
          consent to that relocation, the failure by the Company to pay (or
          reimburse you for) all reasonable moving expenses incurred by you or
          to indemnify you against any loss realized in the sale of your
          principal residence in connection with that relocation;

          (e) The failure by the Company to continue in effect any retirement or
          compensation plan, supplemental retirement plan, performance share
          plan, stock option plan, life insurance plan, health and accident
          plan, disability plan or any other benefit plan in which you are
          participating immediately prior to the Change in Control Date (or
          provide plans providing you with substantially similar benefits), the
          taking of any action by the Company that would adversely affect your
          participation or materially reduce your benefits under any of those
<PAGE>

          plans or deprive you of any material fringe benefit enjoyed by you
          immediately prior to the Change in Control Date, or the failure by the
          Company to provide you with the number of paid vacation days to which
          you are then entitled in accordance with the Company's normal vacation
          practices in effect immediately prior to the Change in Control Date;

          (f) The failure by the Company to obtain the assumption of the
          agreement to perform this Letter by any successor, as contemplated in
          paragraph 6; or

          (g) Any purported termination of your employment that is not effected
          pursuant to a Notice of Termination satisfying the requirements of
          subparagraph 4.4 (and, if applicable, subparagraph 4.1).

     For purposes of this subparagraph 4.3, "Change in Control Date" means the
     date six months prior to the date of the Change in Control.

     4.4  Notice of Termination.  Any purported termination by the Company
          ---------------------
     pursuant to subparagraphs 4.1 or 4.2 or by you pursuant to subparagraph 4.3
     will be communicated by written Notice of Termination to the other party.
     For purposes of this Letter, a "Notice of Termination" means a notice that
     indicates the specific termination provision in this Letter relied upon and
     setting forth in reasonable detail the facts and circumstances claimed to
     provide a basis for termination of your employment under the provision so
     indicated.  Any purported termination not effected pursuant to a Notice of
     Termination meeting the requirements set forth in this Letter will not be
     effective.

     4.5  Date of Termination.  For purposes of this Letter, the date of the
          -------------------
     termination of your employment ("Date of Termination") will be (a) if your
     employment is terminated by your death, the end of the month in which your
     death occurs, (b) if your employment is terminated for Disability, thirty
     (30) days after Notice of Termination is given, or (c) if your employment
     is terminated by you or the Company for any other reason, the date
     specified in the Notice of Termination, which will not be later than thirty
     (30) days after the date on which the Notice of Termination is given.

5.  Benefits upon Certain Terminations following a Change in Control.  If any of
    ----------------------------------------------------------------
the events described in paragraph 3 constituting a Change in Control occurs and
<PAGE>

your employment is terminated under the circumstances described in paragraph 4
which entitle you to payments and benefits under this paragraph 5, then the
following provisions will apply:

     5.1  Compensation through Date of Termination.  The Company will pay you
          ----------------------------------------
     (a) any unpaid amount of your base salary through the Date of Termination,
     (b) with respect to any year then completed, any unpaid amount accrued to
     you pursuant to the Incentive Plan, and (c) with respect to any year then
     partially completed, a pro rata portion through the Date of Termination of
     your target annual bonus under the Incentive Plan.  For purposes of item
     (c) above, your "target annual bonus under the Incentive Plan" will be your
     annual base salary as of the Date of Termination multiplied by the target
     percentage of your bonus under the Incentive Plan.

     5.2  Additional Severance.  In lieu of any further salary payments to you
          --------------------
     for periods subsequent to the Date of Termination, the Company will pay as
     severance pay to you on the fifth (5th) business day following the Date of
     Termination a lump sum equal to three (3) times the sum of (a) your annual
     base salary at the highest rate in effect during the twelve (12) months
     immediately preceding the Date of Termination plus (b) the higher of (i)
     the highest annual bonus paid to you or paid but deferred on your behalf
     under the Incentive Plan, (ii) any earned, but unpaid, bonus accrued for
     your benefit under the Incentive Plan, or (iii) your highest target annual
     bonus under the Incentive Plan, whether or not earned, in each case with
     respect to the three (3) calendar years immediately preceding the year in
     which the Date of Termination occurs and the partial calendar year ending
     on the Date of Termination.  For purposes of item (iii) above and
     subparagraph 5.3, the "highest target annual bonus under the Incentive
     Plan" for the partial calendar year ending on the Date of Termination will
     be your annual base salary as of the Date of Termination multiplied by the
     target percentage of your bonus under the Incentive Plan.

     5.3  Additional Retirement Benefit.  If you are a participant in the
          -----------------------------
     Company's U.S. Retirement Income Plan (the "Retirement Plan"), the Company
     will pay you on the fifth (5th) business day following the Date of
     Termination a lump sum retirement benefit, in addition to the benefits to
     which you are or would be entitled under the Retirement Plan.  That benefit
     will be a lump sum amount that is the actuarial equivalent of your benefits
     calculated pursuant to the terms of the Retirement Plan with the following
     adjustments:  (a) regardless of your Years of Vesting Service under the
     Retirement Plan, you will be treated as if you were 100% vested under the
<PAGE>

     Retirement Plan, (b) the number of Years of Benefit Service used will be
     the actual number of Years of Benefit Service accumulated as of the Date of
     Termination plus an additional number of Years of Benefit Service (up to a
     maximum of five (5) additional years) equal to the number of additional
     Years of Benefit Service that you would have earned if you had remained an
     employee of the Company until attainment of age sixty-two (62), (c) the
     Final Average Earnings (for purposes of applying the benefit formula under
     the Retirement Plan) will be determined using (I) the highest monthly rate
     of Base Salary in effect during the twelve (12) months immediately
     preceding the Date of Termination, plus (II) the higher of (A) the highest
     annual bonus paid to you or paid but deferred on your behalf under the
     Plan, (B) any earned, but unpaid, bonus accrued for your benefit under the
     Plan, or (C) your highest target annual bonus under the Plan, whether or
     not earned, in each case with respect to the three (3) calendar years
     immediately preceding the Date of Termination and the partial calendar year
     ending on the Date of Termination, divided by twelve (12) (regardless of
     the earnings limitations under the Retirement Plan or governmental
     regulations applicable to those plans), and (d) the monthly retirement
     benefit so calculated will be reduced by an amount equal to the monthly
     retirement benefit payable to you under the Retirement Plan.  All
     capitalized terms used in this subparagraph, unless otherwise defined, will
     have the same meanings as those terms are defined in the Retirement Plan.
     The actuarial equivalent will be calculated based on the assumptions
     contained in the Retirement Plan on the Date of Termination; provided that
     the assumptions on which the actuarial equivalent will be calculated will
     be no less favorable to you than those assumptions contained in the
     Retirement Plan on the date of the Change in Control.

     5.4  Benefit Plans.
          -------------

          (a) Unless your employment is terminated for Cause, the Company will
          maintain in full force and effect, for your continued benefit for
          three (3) years after your Date of Termination, the group health,
          dental, vision, life insurance. disability and similar coverages in
          which you are entitled to participate immediately prior to the Date of
          Termination at the same level as for active employees and in the same
          manner as if your employment had not terminated.  Any additional
          coverages you had at termination, including dependent coverage, will
          also be continued for that period on the same terms, to the extent
          permitted by the applicable policies or contracts.  You will be
          responsible for paying any costs you were paying for those coverages
          at the time of termination by separate check payable to the Company
          each month in
<PAGE>

          advance. If the terms of any benefit plan referred to in this
          subparagraph 5.4(a), or the laws applicable to that plan do not permit
          your continued participation, then the Company will arrange for other
          coverages satisfactory to you at the Company's expense that provide
          substantially similar benefits, or the Company will pay you a lump sum
          amount equal to the costs you would have to pay to obtain those
          coverage(s) for the three-year period.

          (b) If you have satisfied the requirements for receiving the Company's
          retiree medical coverage on your Date of Termination or will satisfy
          those requirements prior to the last day of the three-year benefit
          continuation period provided in item (a) above, you (and your
          dependents) will be covered by, and receive benefits under, the
          Company's retiree medical coverage program for employees at your
          level.  Your retiree medical coverage will commence on the date your
          health care coverage terminates under item (a) above, and will
          continue for your life (i.e., the coverage will be vested and may not
          be terminated), subject only to those changes in the level of coverage
          that apply to employees at your level generally.

          (c) You will be entitled to continue to participate in the Company's
          401(k) Retirement and Savings Plan for the three-year period after
          your Date of Termination.  For purposes of the 401(k) Plan, you will
          receive an amount equal to the Company's contributions to the 401(k)
          Plan, assuming you had made contributions to the 401(k) Plan at the
          maximum permissible level.  If the Company cannot contribute those
          additional amounts to the 401(k) Plan on your behalf because of the
          terms of the 401(k) Plan or applicable law, the Company will pay to
          you within five (5) days of the Date of Termination a lump sum amount
          equal to the additional amounts the Company would have been required
          to contribute (based upon the terms of the 401(k) Plan as in effect on
          the Date of Termination).

     5.5  No Mitigation Required.  You will not be required to mitigate the
          ----------------------
     amount of any payment or benefits provided for in this paragraph 5 by
     seeking other employment or otherwise, nor will the amount of any payment
     or benefits provided for in this paragraph 5 be reduced by any compensation
     earned by you, or benefits provided to you, as the result of employment by
     another employer after the Date of Termination, or otherwise.
<PAGE>

     5.6  Tax Gross-Up Payment.  If any payments or benefits provided pursuant
          --------------------
     to this Letter or any other payments or benefits provided to you by the
     Company are subject to an excise tax on an "excess parachute payment" under
     Section 4999 of the Internal Revenue Code of 1986 (the "Code"), or any
     successor provision of the Code, or are subject to an excise or penalty tax
     under any similar provision of any other revenue system to which you may be
     subject, the Company will provide a gross-up payment to you in order to
     place you in the same after-tax position you would have been in had no
     excise or penalty tax become due and payable under Code Section 4999 (or
     any successor provision) or any similar provision of that other revenue
     system.  That gross-up payment will not apply to any excise or penalty tax
     attributable to any incentive stock option granted to you by the Company or
     Equifax Inc. prior to April 1, 1998.  Any gross-up payment to which you are
     entitled as a result of the applicability of an excise tax under Code
     Section 4999 or any successor provision of the Code, or as a result of any
     excise or penalty tax under any similar provision of any other revenue
     system to which you may be subject, will be determined in accordance with a
     "Policy with Respect to Tax Gross-up Payments" adopted, or which will be
     adopted, by the Board of Directors (or a Committee of the Board), and once
     that policy is adopted, no amendment of that policy that adversely affects
     you will be effective with respect to your rights under this Letter without
     your written consent.

6.  Successors: Binding Agreement.
    -----------------------------

     6.1  Assumption by Company's Successor.  The Company will require any
          ---------------------------------
     successor (whether direct or indirect, by purchase, merger, consolidation
     or otherwise) to all or substantially all of the business and/or assets of
     the Company, by agreement in form and substance reasonably satisfactory to
     you, to expressly assume and agree to perform this Letter.  Failure of the
     Company to obtain that agreement prior to the effectiveness of any
     succession will be a breach of this Letter and will entitle you to
     compensation from the Company in the same amount and on the same terms as
     you would be entitled under this Letter if you terminated your employment
     for Good Reason within three (3) years following a Change in Control,
     except that for purposes of implementing the foregoing, the date on which
     that succession becomes effective will be deemed the Date of Termination.
     As used in this Letter, "Company" means Equifax PS, Inc. and any successor
     to its business and/or assets that executes and delivers the agreement
     provided for in this subparagraph 6.1 or that otherwise becomes bound by
     all the terms and provisions of this Letter by operation of law.
<PAGE>

     6.2  Enforcement by Your Successor.  This Letter will inure to the benefit
          -----------------------------
     of and be enforceable by your personal or legal representatives, executors,
     administrators, successors, heirs, distributees, devisees and legatees.  If
     you die subsequent to the termination of your employment while any amount
     would still be payable to you pursuant to this Letter if you had continued
     to live, all those amounts, unless otherwise provided in this Letter, will
     be paid in accordance with the terms of this Letter to your devisee,
     legatee or other designee or, if there be no designee, to your estate; that
     payment to be made in a lump sum within sixty (60) days from the date of
     your death.

7.  Notice.  For purposes of this Letter, notices and all other communications
    ------
provided for in this Letter will be in writing and will be deemed to have been
duly given when delivered or mailed by United States registered mail, return
receipt requested, postage pre-paid, addressed to the respective addresses set
forth on the first page of this Letter, provided that all notices to the Company
will be directed to the attention of the Chief Executive Officer of the Company
(or if the notice is from the Chief Executive Officer, to the General Counsel of
the Company), or to that other address as either party may have furnished to the
other in writing in accordance with this paragraph 7, except that notice of
change of address will be effective only upon receipt.

8.  Modification and Waiver.  No provision of this Letter may be modified,
    -----------------------
waived or discharged unless that waiver, modification or discharge is agreed to
in writing by you and that officer as may be specifically designated by the
Board of Directors of the Company.  No waiver by either party at any time of any
breach by the other party of, or compliance with, any condition or provision of
this Letter to be performed by that other party will be deemed a waiver of
similar or dissimilar provisions or conditions at the time or at any prior or
subsequent time.

9.  Construction.  This Letter supersedes (a) any oral agreement between you and
    ------------
the Company and any oral representation by the Company to you with respect to
the subject matter of this Letter, and (b) that letter agreement dated
__________, ____ between you and Equifax Inc. pertaining to change in control.
The validity, interpretation, construction and performance of this Letter will
be governed by the laws of the State of Georgia.

10.  Severability.   If any one or more of the provisions of this Letter or any
     ------------
word, phrase, clause, sentence or other portion of a provision is deemed illegal
or unenforceable for any reason, that provision or portion will be modified or
deleted in such a manner as to make this Letter as modified legal and
enforceable to the
<PAGE>

fullest extent permitted under applicable laws. The validity and enforceability
of the remaining provisions or portions of this Letter will remain in full force
and effect.

11.  Counterparts.  This Letter may be executed in two or more counterparts,
     ------------
each of which will take effect as an original and all of which will evidence one
and the same agreement.

12.  Legal Fees.  If the Company breaches this Letter or if, within three (3)
     ----------
years following a Change in Control,  your employment is terminated under
circumstances described in paragraph 4 that entitle you to payments and benefits
under paragraph 5, the Company will reimburse you for all legal fees and
expenses reasonably incurred by you as a result of that termination (including
all those fees and expenses, if any, incurred in contesting or disputing the
termination or in seeking to obtain or enforce any right or benefit provided by
this Letter).

Upon presentation to the Company of the invoice for those legal fees and
expenses, the Company will reimburse you monthly for those legal fees and
expenses.

13.  Indemnification.  After your termination, the Company will indemnify you
     ---------------
and hold you harmless from and against any claim relating to your performance as
an officer, director or employee of the Company or any of its subsidiaries or
other affiliates or in any other capacity, including any fiduciary capacity, in
which you served at the Company's request, in each case to the maximum extent
permitted by law and under the Company's Articles of Incorporation and Bylaws
(the "Governing Documents"), provided that under no circumstances will the
protection afforded to you under this paragraph be less than that afforded under
the Governing Documents as in effect on the date of this Agreement except for
changes mandated by law.  You will continue to receive the benefits of, and be
covered by, any policy of directors and officers liability insurance maintained
by the Company for the benefit of its directors, officers and employees.

14.  Employment by a Subsidiary.  Either the Company or a Subsidiary may be your
     --------------------------
legal employer.  For purposes of this Letter, any reference to your termination
of employment with the Company means termination of employment with the Company
and all Subsidiaries, and does not include a transfer of employment between any
of them.  The actions referred to under the definition of "Good Reason" in
subparagraph 4.3 include the actions of the Company or your employing
Subsidiary, as applicable.  The obligations created under this Letter are
obligations of the Company.  A change in control of a Subsidiary will not
constitute a Change in Control for purposes of this Letter unless there is also
a contemporaneous Change in Control of the Company.  For purposes of paragraph 1
<PAGE>

and this paragraph, a "Subsidiary" means an entity more than fifty percent (50%)
of whose equity interests are owned directly or indirectly by the Company.

If you accept the above terms, please sign and return to me the enclosed copy of
this Letter.


Sincerely,



Agreed to as of                 ,
                ---------------- -------
----------------------------------------
[Name]