Legal Dispute Resolution Payment Form

Legal Dispute Resolution Payment Form

This Legal Dispute Resolution Payment Form (the Agreement) is entered into as of by and between Payor Name: of Payor Address: and Payee Name: of Payee Address: . Case/Reference Number:

Recitals

WHEREAS, a dispute arose between Payor and Payee concerning the matters described in the above Case/Reference Number and the parties desire to resolve all claims, causes of action, demands, and disputes between them without further litigation; and

WHEREAS, the parties have reached an agreement on monetary consideration and payment processes to effectuate settlement and mutual release of claims upon the terms and conditions set forth herein; and

WHEREAS, the parties intend for this Agreement to set forth the definitive payment obligations, security, escrow arrangements (if any), and the releases to be exchanged upon receipt and clearance of the agreed payments.

NOW, THEREFORE, in consideration of the mutual covenants and promises contained herein and other good and valuable consideration, the sufficiency of which is acknowledged, the parties agree as follows:

1. Definitions

For purposes of this Agreement, the following terms shall have the meanings set forth below. "Effective Date" means the date first written above. "Payment" means the monetary consideration described in Section 2. "Escrow Agent" means any third party identified in Section 4 to receive and disburse funds pursuant to this Agreement.

2. Payment Terms

Payor shall pay to Payee the total settlement amount of (the Total Settlement Amount), subject to the schedule and conditions set forth below.

Lump sum payment due on or Installments as specified below.

3. Method and Place of Payment

Payments shall be made by the method selected below and shall be deemed made only when actually received and cleared in the account designated by Payee or Escrow Agent.

Wire transfer Check ACH/Automated Clearing House

4. Escrow or Trust Account (If Applicable)

If the parties elect to use an Escrow Agent, the Escrow Agent shall be identified here and shall hold and disburse funds strictly in accordance with the terms set forth in this Agreement. The Escrow Agent shall act only on written joint instruction of the parties or as ordered by a court of competent jurisdiction.

5. Release and Covenant Not to Sue

Upon Payee's receipt and clearance of the Total Settlement Amount in accordance with this Agreement, Payee shall execute a full release and covenant not to sue in favor of Payor, its agents, affiliates, and representatives, releasing all claims related to the Dispute arising prior to the Effective Date. The release shall be in form reasonably acceptable to Payor and shall be executed concurrently with final payment unless otherwise agreed in writing.

6. Taxes and Withholding

Each party is responsible for its own tax reporting obligations and liabilities arising from payments hereunder unless otherwise required by law. To the extent any governmental authority requires withholding or reporting, the withholding party shall provide prompt written notice and cooperate in minimizing tax consequences.

7. Representations and Warranties

Each party represents and warrants that it has full power and authority to enter into this Agreement, that the person signing on its behalf is duly authorized, and that the execution and performance of this Agreement will not violate any agreement or legal obligation to which it is a party.

8. Default; Remedies

If Payor fails to make any payment when due, Payor shall be in default. On default, Payee may pursue all remedies available at law or equity, including acceleration of remaining payments, recovery of interest at the rate of from the date due until paid, and recovery of reasonable attorneys' fees and costs incurred in enforcing this Agreement.

9. Notices

All notices required or permitted under this Agreement shall be in writing and delivered to the addresses set forth below (or to such other address as a party designates by written notice). Notice is effective upon personal delivery, confirmed facsimile, confirmed electronic delivery, or three business days after deposit with a nationally recognized overnight courier.

10. Amendments; Waivers; Counterparts

This Agreement may be amended only by a written instrument executed by both parties. No waiver of any provision shall be effective unless in writing and signed by the waiving party. This Agreement may be executed in counterparts, each of which when so executed shall be deemed an original, and all of which together shall constitute one instrument.

11. Governing Law; Venue

This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction specified by the parties below. Any litigation arising out of or relating to this Agreement shall be brought only in the courts located within the specified jurisdiction unless the parties agree to arbitration in writing.

12. Entire Agreement; Severability

This Agreement constitutes the entire agreement between the parties regarding the subject matter hereof and supersedes all prior discussions, negotiations, and agreements. If any provision of this Agreement is held unenforceable, the remainder of the Agreement shall remain in full force and effect and the unenforceable provision shall be reformed to the minimum extent necessary to make it enforceable.

13. Miscellaneous Provisions

The parties agree to execute such further documents and take such further actions as may be reasonably necessary to carry out the intent of this Agreement. Each party shall cooperate in good faith to accomplish the timely and complete performance contemplated herein.

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