ࡱ> 02/y bjbj .{{ nnnnn8^$VnnnYYYXnnYYYY4, XY.0^YuYnYpY/*^ 4: DEMAND FOR ARBITRATION Please provide the following information in connection with your dispute with Global Response Partners, LLC (Responding Party), as submitted by you or the organization that you represent (Initiating Party and together with the Responding Party, the Parties): Name of the Initiating Party: ____________________________________ Address of the Initiating Party: ____________________________________ ____________________________________ ____________________________________ Telephone Number of Initiating Party: ____________________________________ E-mail Address of Initiating Party: ____________________________________ Name of Responding Party: Global Response Partners, LLC 910 Sylvan Ave., 1st Floor, Suite 125 Englewood Cliffs, NJ Telephone Number of Responding Party: (201) 503-0011 E-mail Address of Responding Party: [INSERT EMAIL ADDRESS] The Initiating Party previously agreed to the GRPAds Publisher Agreement (Agreement). The Agreement contains a valid and binding arbitration clause for the resolution of disputes, a copy of which is attached hereto as Exhibit A. The Parties are in dispute as to the following issue(s): __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ As the Parties cannot agree as to the resolution of the subject dispute, the Initiating Party hereby demands that the Responding Party submit to arbitration pursuant to the rules and procedures set forth by either the American Arbitration Association (AAA), the Judicial Arbitration and Mediation Services, Inc. (JAMS) or another reputable arbitration provider, as selected by the Initiating Party. The Initiating Party is claiming the following damages: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ Total Damages Claimed $ ___________________ In filing this Demand for Arbitration (Demand), the Initiating Party certifies the following: He/she/it has provided the Responding Party with a copy of this Demand by both e-mail and by certified mail, return receipt requested. So demanded and certified, this ___ day of ________________, 20__. ___________________________________________________ Initiating Party Sworn to and subscribed before me, this ___ day of __________________, 20__. ___________________________________________________ Notary Public. (PLEASE NOTE: Notarization is required for original and mailed copies only. 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