Request Mediation/Arbitration * Required Fields

Number of Days Needed:* 1/2 day 1 day 2 or more days Time Period Needed:* On or before: (mm/dd/yyyy)   OR Between:(mm/dd/yyyy)   AND   (mm/dd/yyyy) Approximate Damages in Dispute:* $ Number and Names of Parties in Dispute: (parties represented by the same attorney or firm are deemed one party for purposes of the mediation/arbitration fee:) *Name: Firm Name (if any): *Phone Number:   Fax Number: Alt. Phone Number:     *Email Address: Would You Like a Resume Sent to You? Yes, send me an email Yes, send me a fax No, send me nothing

If your request is received during business hours, you should receive a reply the same day; otherwise a reply will be forwarded to you the next business morning. Thank you!