Arbitration Opt-Out Form

I am writing to provide Greenlight Financial Technology, Inc. (“Greenlight”) with notice that I am opting out of the agreement to arbitrate, which is included in the Greenlight Terms of Service and various other Terms of Service or Terms of Use (collectively, the “Terms”) that are available on the Greenlight website (greenlight.com) (the “Website”) or on the Greenlight application for a mobile phone, tablet or any other portable device (the “Application”).  Pursuant to the terms of the agreement to Arbitrate, I’m providing the requested information as follows:

My Full Name:

My Street Address:

City:

State:

Zip Code:

Cell Phone Number:

Terms URL:

Please include full name, email address, cell phone number, and last four digits of Greenlight Prepaid Mastercard Account number associated with the Greenlight account (and any associated child accounts) for which I’m opting out of the agreement to Arbitrate: (Please list all email addresses associated with the account.)

Signature:

Date:

Please mail the completed form to the following address:

Greenlight Financial Technology, Inc.

Attn: Customer Service – Arbitration Opt-Out

303 Peachtree St. NE, Suite 4300

Atlanta, GA 30308