AFFILIATE E-AGREEMENT

Section I: Acceptance of the Agreement

Welcome to Good Driver Mutuality Inc. (“Company”), which serves as the administrator of the Good Driver Club Program, an auto loss sharing program. Please read the written Affiliate Application & Agreement, the Statement of Policies and Procedures, the Affiliate and Referral Program (only those sections apply to Affiliate), the Privacy Policy, the Good Driver Club Program Disclosure, the Retention Rate Rules, the Marketing Rules,and the Terms of Use carefully, collectively referred to as the “Agreement.” You also specifically agree to the Dispute Resolution and Arbitration provisions within the Good Driver Club Program Statement Policies and Procedures.

Section II: Enrollment

At the time of your enrollment into the Good Driver Club Program business, you must take a quiz to demonstrate your understanding of the Good Driver Club Program and pay a $9.90 enrollment fee. Please note that the payment associated with this fee is non-commissionable. Cancellation requests will be effective in the calendar month in which the Company receives written notice unless the debit has already been processed. If the notice to cancel is received after the debit has been processed, the cancellation will be effective in the following calendar month.

Section III: E-Sign Notice- Consent to Electronic Record

E-Sign, the Electronic Signatures in Global and National Commerce Act (15 U.S.C. § 7001, et seq.), requires that you consent to entering into an electronic agreement with the Company before an Affiliate Agreement can be executed.

Please read the following information carefully:

• If you enter into an online Affiliate Application & Agreement with the Comany, you will not be required to submit a paper application. An electronic record will evidence the entire agreement between you and the Company. However, you must consent to the use of an electronic record and must read the Agreement and electronically acknowledge below that you understand and have read these documents.

• To access these documents and submit your online Affiliate Application & Agreement, you will need a personal computer, or other device with Internet access and operational Internet browser software.

  By clicking on “I agree” below, you consent to the use of electronic records evidencing that you have read, understand, and agree to the Agreement. If you click on the “I Decline” box, the enrollment process will be terminated, and you will be returned to the CompanyHome page.

Section IV: IRS W9 Information

The Tax ID number must match the name as shown on your income tax return to avoid backup withholding. For individuals, this is your social security number.

Please verify the information submitted on your enrollment form. If correct, acknowledge by checking the box below, which will serve as your digital signature. For further information, please see the official IRS W9 form instructions: http://www.irs.gov/pub/irs-pdf/fw9.pdf

Under penalty of perjury, I certify that:

• The taxpayer identification number I submitted is my correct taxpayer identification number (or I am waiting for a number to be issued to me);

  • I am not subject to backup withholding because:

  • I am exempt from backup withholding, or

  • I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or

  • The IRS has notified me that I am no longer subject to backup withholding, and

• I am a U.S. citizen or other U.S. person (a U.S. resident alien, a partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, an estate (other than a foreign estate), or a domestic trust (as defined in 26 CFR 301.7701-7).

I consent to the use of electronic records and have read, understand and agree to the Agreement.