Parent Employment Loan Document

Parent Employment Loan Document

Parties and Identifying Information

Employer Name:

Borrower (Parent) Name:

Employee (Related Party) Information

Position Information (Employee)

Reporting Manager:     Start Date:

Employment History (Employee) — Most Recent Two Employers

Education

References (Employee)

Loan Agreement — Material Terms

Date of Agreement:

Disbursement Date:     Interest Rate (annual, fixed):

Term: months     Monthly Payment (if known):

Repayment, Payroll Deduction, and Guaranty

Repayment Method: The Borrower agrees to repay according to the amortization set forth above. Employer may, with Borrower consent, effect repayment by payroll deduction from the employee related to the Borrower (the "Employee"). Authorization given below is a continuing authorization until the loan is paid in full or otherwise terminated by written agreement.

Employee Authorizes Payroll Deduction:    If authorized, maximum deduction per pay period:

By signing below, Borrower acknowledges that Employee may be required to execute a separate payroll deduction authorization and that Employee's failure to authorize deductions will not release Borrower from repayment obligations. The Employer's acceptance of this loan is contingent on the Employer's internal approval process and may be rescinded consistent with company policy.

Default, Remedies, and Acceleration

Default Events: Borrower will be in default upon (a) failure to make any payment within 15 days of its due date; (b) any material breach of a representation or warranty contained herein; (c) commencement by or against Borrower of insolvency proceedings; or (d) any material adverse change in Borrower's financial condition. Upon default, Employer may accelerate the entire outstanding principal and accrued interest, charge a late fee of , and pursue all remedies available at law or equity.

Borrower may prepay in whole or in part without penalty unless otherwise specified:   If checked, describe penalty:

Representations, Warranties and Authorizations

Borrower represents and warrants that all information provided in this document is true and complete, that Borrower has the authority to enter into this Agreement, and that the funds will be used for the stated purpose. Borrower authorizes Employer to obtain credit and employment verifications as necessary to evaluate and administer this loan.

Borrower consents to employer-initiated background and credit checks to the extent permitted by law:

Tax Treatment and Reporting

Borrower and Employer acknowledge that the tax treatment of this loan may vary based on facts and applicable law. Borrower is solely responsible for reporting any taxable benefit and for any tax consequences that arise from the forgiveness, write-off, or subsidization of the loan. Employer may issue tax reporting forms as required by law.

Notices

Confidentiality, Governing Law, and Dispute Resolution

The parties agree to keep the terms of this Agreement confidential except as required by law or as necessary for enforcement. This Agreement shall be governed by the laws of the state identified in the Employer's internal policy or, if not specified, the state where Employer is incorporated. Any dispute arising out of or relating to this Agreement shall be resolved by binding arbitration unless otherwise required by law.

Borrower Certification and Acknowledgment

I certify that all information provided on this form is true and complete to the best of my knowledge. I understand that knowingly providing false information may constitute fraud and may subject me to civil or criminal penalties. I authorize the Employer to take the actions necessary to effectuate disbursement and repayment as described above.

Equal Employment and At-Will Statement

Employer is an equal opportunity employer. Participation in this loan program is not an employment guarantee. Nothing in this Agreement amends, alters, or supersedes the at-will employment relationship between Employer and Employee unless an express written employment agreement states otherwise.

Execution

The undersigned parties, intending to be legally bound, have executed this Parent Employment Loan Document as of the dates set forth below.

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