Arbitration Request

Administrative Fee to open a matter is $200.

Parties

Claimant/Petitioner

First name

Last name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Attorney/Firm Name (if applicable)

Address

Phone

Additional Claimants, if applicable

Respondent/Defendant

First Name

Last Name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Attorney/Firm Name

Address

Phone

Additional Respondents, if applicable

Administrative

Please choose the manner of arbitration.

Single Arbitrator

Panel of Arbitrators

Other

If you believe the arbitrator should have specialized expertise, please identify the area of expertise:

If using other arbitrators, please fill in their name(s).

Please indicate whether there is agreement to arbitrate:

All Parties Agree

Only Party With Demands Agrees

A $200 Admin & Filing Fee is charged for each arbitration opened. Please indicate whether the demanding party will pay the $200 Admin Fee or whether there is an agreement among the parties to share/split the Admin Fee.

Demanding Party Will Pay The Fees

All Parties Agree To Split The Fees

Plead Your Claims or Cause(s) of Action

In a short and concise manner, list the claims you assert against the Respondent/Defendant:

Identity the types and amounts of damages you seek: