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Agreement by and between _______________ [Name] of _______________ [Address] and _______________ [Name] of _______________ [Address].
Be it acknowledged, that we the undersigned as our interests exist in and to a certain contract, dispute, controversy, action or claim described as: _______________ (claim) do hereby agree to resolve any dispute or controversy we now have or may ever have in connection with or arising from said claim by binding Arbitration.
Said Arbitration shall be in accordance with the rules and procedures of the American Arbitration for the City of _______________, which rules and procedures for arbitration are incorporated herein by reference and the decision or award by the Arbitrators shall be final, conclusive and binding upon each of us and enforceable in a court of law of proper jurisdiction. All costs of arbitration shall be shared equally except that each party shall pay his own legal costs.
Signed this __________ day of_________, 20 __.
In the presence of:
Witness First Party
Witness Second Party
*** If Required By State Law ***
This Section for Notary:
State of _________
County of ________ [COUNTY]
On [DATE] before me, [NAME OF NOTARY], notary, personally appeared [NAME OF PERSON(S) INVOLVED], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
My commission expires: _____