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Agreement to Arbitrate Online This Agreement to provide online arbitration services (the Agreement) is between ArbiClaims located at https://arbi-claims.squarespace.com on the Worldwide Web with its main office located at       , and (Street Address, City, County, State, Zip Code) referred to herein as ArbiClaims , of       , (Street Address, City, County, State, Zip Code) referred to herein as Claimant, and       , (Name of Respondent) a corporation organized and existing under the laws of the state of       , (Name of State) with its principal office located at       , (Street Address, City, County, State, Zip Code) referred to herein as Respondent. Claimant and Respondent are sometimes referred to herein as the Parties. Whereas, certain disputes and controversies have arisen and exist between the Claimant and Respondent with regard to             ; and (Describe subject matter to be arbitrated.) Whereas, Claimant and Respondent have agreed to submit their Dispute to ArbiClaims and be bound by and be governed by the rules of the American Arbitration Association now in force and effect , which are found at https://www.adr.org/aaa/faces/rules and are incorporated herein by reference. All terms used herein will be defined as set forth in said Rules; Now, therefore, for and in consideration of the mutual covenants contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Submission to Arbitration. The parties agree to refer and submit all disputes, differences, and controversies in connection with the above-stated matter to the arbitration of an arbitrator named by ArbiClaims so that he may receive and consider all evidence offered by the parties relating to the             (Specify contract or dispute) and make his award in writing, signed by him concerning the matters referred, to be delivered to the Parties on or before       . (Date) 2. Entering Judgment. The Parties agree that judgment may be entered on the award in any court of competent jurisdiction in       , and that such award (Name of state) Agreement to Arbitrate Online Page 1 of 5 shall be final as to the Parties and issues encompassed in this Agreement. 3. Accountant or other Appropriate Professional May Assist Arbitrator. The Parties agree that the chosen Arbitrator is authorized to appoint an accountant or another appropriate professional to assist him, at the expense of the Parties. 4. Expenses.       is authorized to incur (Name of Arbitrator) any other necessary expenses in connection with the arbitration, and the Parties agree to share equally such expenses, including compensation to       (Name of Arbitrator) in an amount not more than       . (Dollar Amount) 5. Governing Law. This Agreement shall be governed by, construed, and enforced in accordance with the laws of the state of       . 6. The Parties understand and agree that no oral presentations will be made to the Arbitrator; that there will be no “hearings” in which a Party shall present information to the Arbitrator; that all submissions shall be in writing only; that the Arbitrator will base the award solely only upon such written submissions; and that the Parties are bound by the Arbitrator’s decision which will be set forth as an Award. 7. The Parties further agree not to: A. Impersonate any person or entity or use a name or alias that they are not authorized to use; B. Forge communications transmitted to the Arbitrator either directly or through ArbiClaims ; C. Transmit any material that encourages conduct that could constitute a criminal offense, or give rise to civil liability or to transmit any unlawful, harassing libelous, abusive, threatening, harmful, vulgar, obscene or otherwise objectionable material of any kind or nature, as determined by ArbiClaims ; D. Reproduce, modify distribute or publicly display ArbiClaims ’ on-line materials. 8. The Parties understand and agree that irrespective of where either Party to the Case or the Arbitrator resides, ArbiClaims Services provided under this Agreement, will be deemed to have occurred in the State of       , in the United States of America. 9. Neither ArbiClaims nor any Arbitrator makes any warranty, representation or guaranty to any of the Parties, and to the extent permitted by law, ArbiClaims expressly disclaims any and all other warranties, express or implied; any and all implied warranties, including, without limitation the implied warranties of merchantability, fitness for a particular purpose and non-infringement; and any liability for negligence. Agreement to Arbitrate Online Page 2 of 5 10. ArbiClaims will not be liable for any indirect, special, punitive, incidental or consequential damages arising out of or in connection with this Agreement regardless of whether or not it has been informed of same. 11. The Parties a gree to pay the fees set forth at the Arbitration Fees area found at http://www.squaretrade.com/xxxxx in connection with any Arbitration conducted pursuant to this Agreement. Payment will be due upon commencement of the Arbitration. 12. The Parties agree that the Arbitrator’s decision and Award may include costs of the prevailing party, including an amount equal to the arbitration fee, witness fees, and service of subpoenas. The Parties further agree that where the dispute arises out of a contract which provides for attorneys' fees, the Award may include attorneys' fees, and that each Party shall complete a statement of costs prior to the hearing and present it to the Arbitrator for consideration should he or she prevail. 13. The Parties agree that they may settle the issue between them by agreement at any time. In such event, upon notification to ArbiClaims and to the Arbitrator, the arbitration proceedings shall be terminated and termination shall be recorded in the Case file. 14. The Parties acknowledge and agree that the standards of the Uniform Electronic Transactions Act 1 , as adopted and applied in the State of       shall apply with regard to execution by the Parties of this Agreement as well as to the execution and submission by the Parties of any and all documents and agreements pertaining to the services of ArbiClaims and any and all writings, affirmations, affidavits, declarations or sworn testimony that are submitted. 15. The Parties agree that ArbiClaims shall not be liable to any Party for its failure to perform under this Agreement to the extent that any such failure results from any cause beyond the reasonable control of ArbiClaims , including without limitation, acts of God, strike, electrical or power outage, the acts or omissions of a third party, earthquake, or weather. 16 . The Parties acknowledge and agree that the laws of the state of       will govern this Agreement and your relationship to ArbiClaims , without reference to any choice of law rules. Any dispute concerning services provided by ArbiClaims under this Agreement must be submitted to mediation prior to filing an action against ArbiClaims All actions concerning the services of ArbiClaims arising from this Agreement must be brought in the state or federal courts in the state of       . 17. Severability. The invalidity of any portion of this Agreement will not and shall not be deemed to affect the validity of any other provision. If any provision of this Agreement is held to be invalid, the Parties agree that the remaining provisions shall be deemed to be in full force and effect as if they had been executed by both Parties subsequent to the expungement of the invalid provision. 1 The Uniform Electronic Transactions Act ( UETA ) is one of the several United States Uniform Acts proposed by the National Conference of Commissioners on Uniform State Laws (NCCUSL). Forty-seven states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands have adopted the UETA . Agreement to Arbitrate Online Page 3 of 5 18. No Waiver. The failure of any Party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement, or the waiver of any breach of any of the terms and conditions of this Agreement, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. 19. Notices. Unless provided herein to the contrary, any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement. 20. Entire Agreement. This Agreement shall constitute the entire agreement between the Parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either Party except to the extent incorporated in this Agreement. 21. Modification of Agreement. Any modification of this Agreement or additional obligation assumed by any Party in connection with this Agreement shall be binding only if placed in writing and signed by each Party or an authorized representative of each Party. 22. Assignment of Rights. The rights of each party under this Agreement are personal to that Party and may not be assigned or transferred to any other person, firm, corporation, or other entity without the prior, express, and written consent of the other Parties. 23. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute but one and the same instrument. 24. The use of the masculine gender shall be construed to include the feminine gender . Witness our signatures this the       day of       , 20       .       ( Name of Respondent ) By: (Signature of Claimant) (Signature of Officer)             (P rinted Name of Claimant) (P rinted Name & Office in Corporation) Telephone No.       Telephone No.       Fax No.       Fax No.       E-Mail       E-Mail       Agreement to Arbitrate Online Page 4 of 5 ArbiClaims By: (Signature of Officer)       (P rinted Name & Office in Corporation) Telephone No.       Fax No.       E-Mail       Agreement to Arbitrate Online Page 5 of 5