- 1 - Termination of Agreement and Release (General) This Agreement is by and between 1. (insert name of the assigner) (business address of the assigner) Herein after referred to as 1st party. 2. (insert name of the assigner) (business address of the assigner) Hereinafter referred to as 2nd Party. Whereas the parties entered into an agreement on (insert the date of the Original Agreement). Hereinafter referred to as Original Agreement. The purpose of the agreement was (describe the purpose of original agreement) Whereas, the parties now wish to terminate the original agreement for the following reasons (Insert the reasons for termination). Now therefore in consideration of the all good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows 1. The original Agreement is hereby terminated effective the date of this agreement. 2. The parties hereby release and forever discharge one another of and from all actions, cause of actions, suits debts, obligation of claims, and demands whatsoever which they have or hereafter can, shall or may have under the terms of the original agreement. 3. Binding Effect: This Agreement shall be binding upon and inure to the benefit of the parties and their respective legal representatives, successors and permitted assigns. 4. Governing Law and Jurisdiction: This Agreement shall be governed by and construed in accordance with the laws of United States of America, without regard to the application of principles of conflicts of law. The parties hereby consent to agree that the competent court in (insert the state name) shall have sole jurisdiction over any and all matters arising from this Agreement. - 2 - 5. Counter parts: This agreement may be executed in several counter parts, each of which shall constitute an original and all of which when taken together, shall constitute one agreement. In witness Whereof, the parties have caused this agreement to be executed the day and year first above written. 1st Party Name: Print Name: Address: 2nd Party : Name: Print Name: Address: I, the undersigned, a Notary Public in and for said County, in aforesaid state, Do hereby certify that Personally known to me to be the same person whose name is subscribed to the foregoing instrument, appeared before me this day in person, and acknowledged that signed, scaled and delivered the said instrument, as his/ her/their free and voluntary act, for the uses and purposes therein set forth. Given under my hand and notarial seal, this day of , 20 . Signature of the Notary public (seal) Printed Name of the Notary public American LegalNet, Inc. © www.FormsWorkFlow.com