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Oath Inc.

Consumer Demand for Arbitration before the

American Arbitration Association

AMERICAN ARBITRATION ASSOCIATION

CONSUMER ARBITRATION RULES

To file a claim:

1. Please fill out this form and retain one copy for your records.

2. Mail two copies of this form to the American Arbitration Association’s Case Filing Services, 1101 Laurel Oak Road, Suite 100, Voorhees, NJ 08043. Please include with each form any documentation you may have relating to your dispute and a copy of Oath’s Arbitration provisions, found in Oath’s Terms of Service. If you have any questions, visit www.adr.org or call AAA Customer Service at (800) 778-7879.

3. Send a copy of your completed form to: Oath Inc., Dept. 5627, PO Box 65101, Sterling, VA 20165.

4. Oath will pay your AAA filing fees, provided your amount in dispute is less than $75,000.  If your amount in dispute is more than $75,000, please send the appropriate filing fee to the AAA with these forms.  Information about filing fees can be found in Section L-3 of AAA’s Consumer Arbitration Rules.

Your Personal Information:

Name: __________________________________________________________________________________

AOL Email Address / Username: _____________________Alternate Email Address_____________________

Street Address/City/State/Zip: _______________________________________________________________

Telephone: (____)______________________________ Fax: (____)_________________________________

If an in-person hearing is held, the arbitration will take place in the county of your billing address.  Please tell us the county and state of your billing address with us: ________________________.

Your Attorney’s Information (Please leave blank if you are representing yourself)

Attorney’s Name: _________________________________ Firm: _____________________________________

Address: _________________________________________ City/State/Zip: ____________________________

Telephone: (____)________________________________ Fax: (____)_________________________________

Briefly explain the nature of your dispute.  You may use additional pages:

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

How much money do you believe you are owed?  If none, leave blank:

$___________

Do you desire any non-monetary outcome?  If no, leave blank:

_________________________________________________________________________________________

Signature________________________________________________ Date_________________