Fill and Sign the Agreement Arbitration Form

Agreement to Submit to Arbitration -- General Agreement made on the ___________________ (date), between _______________________ (Name of Claimant) of ___________________________ ____________________________________________________ (street address, city, state, zip code) , referred to herein as Claimant, and _________________________ (Name of Respondent), a corporation organized and existing under the laws of the state of ______________, with its principal office located at ______________________ ________________________________________________________ (street address, city, state, zip code), referred to herein as Respondent. Whereas, certain disputes and controversies have arisen and exist between the above-named parties respecting (describe subject matter to be arbitrated) _______ ____________________________________________________________________________________________________________________________________________ ______________________________________________________________________ __________________________________________________________________; andWhereas, the parties desire to submit the above-stated disputes and controversies to arbitration in accordance with this Agreement;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 ____________________ (name of arbitrator), of __________________________________________________ ___________________________ (street address, city, state, zip code), as arbitrator, 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 __________________ (name of state), and that such award shall be final as to the parties and issues encompassed in this Agreement. 3. Accountant May Assist Arbitrator The parties agree that _______________________ (name of arbitrator) is authorized to appoint an accountant to assist him, at the expense of the parties. 4.Expenses ________________________ (Name of Arbitrator) is authorized to incur 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 _______________ (state). ___________________________ (Name of Respondent) ________________________ By:________________________________ (Printed Name of Claimant) _________________________ ________________________ (Printed name & Office in Corporation) (Signature of Claimant) _________________________ (Signature of Officer)