RELEASE AGREEMENT

This Release Agreement (the “Agreement”), consisting of two (4) numbered pages, is entered into by and between ___________, Inc. (“XYZ”); and __________________ (123).  XYZ and 123 Co. are collectively referred to hereinafter as “the Parties.”

RECITALS

_____________ has experienced circumstances of injury that may or may not be due to the XYZ Product (the “Injury”).

The Parties wish to resolve this matter rather than engage in litigation.  Accordingly, it is the intention of the Parties to use this Agreement as a complete, full and final settlement with regard to the Injury.

In consideration of valuable consideration, the sufficiency of which is hereby acknowledged, the Parties hereby agree as follows:

1.         Settlement Agreement.

XYZ agrees to refund five (5) months of service to 123 Co. for a total payment of ___________ thousand dollars ($__,000).

XYZ agrees to release 123 Co. from any further payment obligations under the agreement.

123 Co. agrees to release XYZ from any obligation for ongoing services under the agreement.

123 Co. agrees to cease ___________

2.         Release Agreements

XYZ hereby release 123 Co. and forever discharge, jointly and severally, their respective officers, directors, share­holders, agents, employees and representatives, from any and all debts, obligations, liabilities, damages, claims, rights, demands, actions, causes of action (collectively, "Claims"), arising, directly or indirectly, out of said Dispute and out of any aspect of XYZ’s relationship with 123 Co..

123 Co. hereby release XYZ and forever discharge, jointly and severally, their respective officers, directors, share­holders, agents, employees and representatives, from any and all debts, obligations, liabilities, damages, claims, rights, demands, actions, causes of action (collectively, "Claims"), arising, directly or indirectly, out of said Dispute and out of any aspect of 123 Co. relationship with XYZ.

It is the intention of 123 Co. and XYZ that this Agreement be effective as a full and final accord and satisfactory release of each and every matter to which specific or general reference is made