Copyright Envision Corporation. 2002. All rights reserved.

Protected by the copyright laws of the United States & Canada and by nternational treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" *E SUE% $ A C(U&! (, "A/.

Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by international treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" *E SUE% $ A C(U&! (, "A/.

Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States and Canada and by international treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" AU!(.A! CA""' *E SUE% $ A C(U&! (, "A/.

DISPUTED ACCOUNT SETTLEMENT

!his Agree0ent on %isp1ted Acco1nt 2the 3Agree0ent45+ is 0ade and effective 6E,,EC! -E %A!E7+

BETWEEN:

[CREDITOR NAME] 2the 8Creditor85 a corporation organi9ed and e:isting 1nder the laws of the 6S!A!E;P&(- $CE7+ with its head office located at<

AND:

[DEBTOR NAME] 2the 8%ebtor85 a corporation organi9ed and e:isting 1nder the laws of the 6S!A!E;P&(- $CE7+ with its head office located at<

/)E&EAS+ Creditor asserts to hold certain clai0 against %ebtor in the a0o1nt of 6A.(U$!7arising fro0 the below described transaction< 6%ESC& *E7

A$% /)E&EAS+ %ebtor disp1tes said clai0+ and denies said debt is d1e= A$% /)E&EAS+ the parties desire to resolve and forever settle and ad>1st said clai0.

%isp1ted Acco1nt Settle0ent

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 Copyright Envision Corporation. 2002. All rights reserved. Protected by the copyright laws of the United States & Canada and by nternational treaties. ! S ""E#A" A$% S!& C!"' P&() * !E% !( % S!& *U!E+ PU*" S)+ (,,E& ,(& SA"E+ " CE$SE (& SU*" CE$SE+ # -E (& % SC"(SE !( A$' (!)E& PA&!'+ !) S P&(%UC! $ )A&% C(P' (& % # !A" ,(&.. A"" (,,E$%E&S / "" *E SUE% $ A C(U&! (, "A/.

$(/+ !)E&E,(&E+ %ebtor agrees to pay to Creditor and Creditor agrees to accept fro0 %ebtor si01ltaneo1s herewith+ the s10 of 6A.(U$!7 in f1ll pay0ent+ settle0ent+ satisfaction+ discharge and release of said clai0 and in release of any f1rther clai0s thereto. Creditor ac@nowledges that there shall be no adverse report filed against %ebtor with any credit b1rea1. !his agree0ent shall be binding 1pon and in1re to the benefit of the parties+ their s1ccessors+ assigns and personal representatives.

E:ec1ted 1nder seal in d1plicate on 6%A!E7.

Signed+ Sealed and %elivered in the Presence of

C&E% !(&

%E*!(&

A1thori9ed Signat1re

A1thori9ed Signat1re

Print $a0e and !itle

Print $a0e and !itle

%isp1ted Acco1nt Settle0ent

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