Small Claim Mediation Agreement 01/18 1 | Page IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF WASHINGTON Small Claims Department Case No: vs. MEDIATION AGREEMENT The parties agree to the following terms which is approved as a mediated agreement: American LegalNet, Inc. www.FormsWorkFlow.com Small Claim Mediation Agreement 01/18 2 | Page The parties further agree that if does not comply with the terms of this Mediation Agreement, may file a declaration of noncompliance and a judgment may be entered against: for $, less any money paid in accordance with this Mediation Agreement, plus costs and service fees in the amount of $ and the statutory prevailing fee (ORS 20.190). Without further order of the court, the dismissal shall be set aside upon submission of a Declaration of Noncompliance and Request for Judgment. Date: Signature of Plaintiff (s) Signature of Defendant (s) Signature of Mediator Court Interpreter Assigned to Case American LegalNet, Inc. www.FormsWorkFlow.com