Application For Electronic Refund Account And (If So Designated) Refund Anticipation Loan (Ral) Form (Page 3 of 4) in pdf

E. Arbitration organizations and procedures. Any party to a dispute, including related third parties, may send the other party written notice by certified mail

return receipt requested of their intent to arbitrate and setting forth the subject of the dispute along with the relief requested, even if a lawsuit has been filed.

Regardless of who demands arbitration, you shall have the right to select any of the following arbitration organizations to administer the arbitration: the

American Arbitration Association (1-800-778-7879) , J.A.M.S./Endispute (1-800-626-5267) , or National

Arbitration Forum (1-800-474-2371) However, the parties may agree to select a local arbitrator who is an attorney, retired judge,

or arbitrator registered and in good standing with an arbitration association and arbitrate pursuant to such arbitrator's rules. The party receiving notice of

arbitration will respond in writing by certified mail return receipt requested within twenty (20) days. If you demand arbitration, you must inform us in your

demand of the arbitration organization you have selected or whether you desire to select a local arbitrator. If related third parties or we demand arbitration,

you must notify us within twenty (20) days in writing by certified mail return receipt requested of your decision to select an arbitration organization or your

desire to select a local arbitrator. If you fail to notify us, then we have the right to select an arbitration organization. The parties to such dispute will be

governed by the rules and procedures of such arbitration organization applicable to consumer disputes, to the extent those rules and procedures do not

contradict the express terms of this arbitration provision, including the limitations on the arbitrator below. You may obtain a copy of the rules and procedures

by contacting the arbitration organization listed above.

F. Payment of arbitration fees. Regardless of who demands arbitration, then at your request we will advance your portion of the expenses associated with

the arbitration, including the filing, administrative, hearing and arbitrator's fees ("Arbitration Fees"). The arbitration hearing will be conducted in the county of

your residence, or within 30 miles from such county, or in the county in which the transaction under this Loan Agreement occurred, or in such place as shall

be ordered by the arbitrator. Throughout the arbitration, each party shall bear their own attorneys' fees and expenses, such as witness and expert witness

fees. The arbitrator shall apply applicable substantive law consistent with the Federal Arbitration Act, 9 U.S.C. Sections 1 –16 ("FAA"); shall apply statutes of

limitation; and shall honor claims of privilege recognized at law. The arbitrator may decide, with or without a hearing, any motion that is substantially similar

to a motion to dismiss for failure to state a claim or a motion for summary judgment. In conducting the arbitration proceeding, the arbitrator shall not apply

any federal or state rules of civil procedure or evidence. If allowed by statute or applicable law, the arbitrator may award a party's reasonable attorneys' fees

and expenses. If the arbitrator renders a decision or an award in your favor resolving the dispute, then you will not be responsible for reimbursing us for your

portion of the Arbitration Fees, and we will reimburse you for any Arbitration Fees you have previously paid. If the arbitrator does not render a decision or an

award in your favor resolving the dispute, then the arbitrator may require you to reimburse us for the Arbitration Fees we have advanced, not to exceed the

amount which could have been assessed as court costs if the dispute had been resolved by a state court with jurisdiction, less any Arbitration Fees you

have previously paid. At the timely request of any party, the arbitrator shall provide a written explanation for the award. The arbitrator's award may be filed

with any court having jurisdiction.

G. Small claims tribunal. All parties, including related third parties, shall retain the right to seek adjudication in a small claims tribunal for disputes within the

scope of such tribunal’s jurisdiction. Any dispute, which cannot be adjudicated within the jurisdiction of a small claims tribunal, shall be resolved by binding

arbitration. Any appeal of a judgment from a small claims tribunal shall be resolved by binding arbitration de novo, by a fresh review of the facts.

H. Governing law. Our agreement to arbitrate is made pursuant to the FAA, because the transaction evidenced by this Agreement involves interstate

commerce. If a final non-appealable judgment of a court having jurisdiction over this transaction finds, for any reason, that the FAA does not apply to this

transaction, then our agreement to arbitrate shall be governed by the arbitration law of the Commonwealth of Kentucky.

I. Binding effect. This arbitration provision is binding upon and benefits you, your respective heirs, successors and assigns. This arbitration provision is

binding upon and benefits us, our successors and assigns, and related third parties. This arbitration provision continues in full force and effect, even if your

obligations have been paid or discharged through bankruptcy. This arbitration provision survives any cancellation by prepayment, termination, amendment,

expiration or performance of any transaction between you and us and continues in full force and effect unless you and we otherwise agree in writing.

If applying for

Federal Refund Summary

a RAL

an ERC or ERD

The Preparer can use this worksheet

complete the appropriate column to the right)

(

to help estimate the amount of the

taxpayer’s check(s).

Federal Refund Amount.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Please note that the fees due to your

TRP, ERO and Transmitter may be

Selected Loan Amount

(from page 1, section 5.). . . . . . . . . . . . . . . . . . . .

withheld from either the federal or

(enter $750 for a Now Ral, $5000 for loan #1, $2199 for loan #2, etc)

state refund.

These fees will be

Actual Loan Amount

(lesser of line 1 or 2) . . . . . . . . . . . . . . . . . . . . . . . .

withheld from whichever refund is

eceived first.

Florida State Doc. Tax

(applicable if taxpayer is a Florida resident). . . . .

This worksheet is not a Truth-In-

Lending Disclosure.

Total TRP/ ERO / Transmitter Fees

(enter the total of the Tax Prep,

5. _______________ ______________

Doc. Prep., SB/Elec. Filing, & Transmitter fees from page 1, section 2) . . .

State Refund Summary

Estimated Bank Fee

(from page 1, section 2). . . . . . . . . . . . . . . . . . . . . . .

State Refund Amount

______________

. . . . . .

Total estimated fees

(line 4 + 5 + 6 ). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Projected Bank Fee.

. ______________

. . . . . . . .

Projected Amount of First Check.

. . . . . . . . . . . . . . . . . . . . . . . . . . .

(for a RAL: line 3 minus 7; for a ERC or ERD: line 1 minus 7)

Projected Amt of Check

. . ..

(line 1 minus 2)

Projected Amount of Second (overage) Check.

. . . . . . . . . . . . .

(line 1 minus 3)

EQUAL CREDIT OPPORTUNITY

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against applicants on the basis of race, color, religion, national origin, sex,

marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any

public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal agency that

administers compliance with this law concerning Republic Bank & Trust Company is the Federal Deposit Insurance Corporation, 2345 Grand Boulevard, Suite

100, Kansas City Missouri 64108.

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Application For Electronic Refund Account And (If So Designated) Refund Anticipation Loan (Ral) Form Page 3

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