SUBMISSION TO DISPUTE RESOLUTION
Date:___________________
The named parties hereby submit the following dispute for resolution under
the Rules of Pacific ADR Services.
Procedure Selected: Binding Arbitration___ Mediation___ Other (describe)____________________
Nature of Dispute (attach additional sheets if necessary.):
Claim or Relief Sought (the amount, if any):
Types of Business: Claimant______________________________________
Respondent___________________________________
Place of Hearing:_______________________________________________
We agree that, if binding arbitration is selected, we will abide by and perform any award rendered hereunder and that a judgment may be entered on the Award.
_______________________________ ________________________________
Name of Party Name of Party
____________________________________________ ____________________________________________
Address Address
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
Telephone ( )______________________________ Telephone ( )______________________________
FAX_________________________________________ FAX________________________________________
Signature_____________________________________ Signature___________________________________
____________________________________________ ____________________________________________
Name of PartyÕs Atty or Representative Name of PartyÕs Atty or Representative
____________________________________________ ____________________________________________
Firm Name Firm Name
____________________________________________ _____________________________________________
Address Address
____________________________________________ _____________________________________________
Tel ( )______________FAX___________________ Tel ( )________________FAX__________________
Signature___________________________________ Signature____________________________________
To institute proceedings, please send two copies of this demand and the arbitration agreement, with the filing fee as provided in the Rules, to Pacific ADR Services. Send the original demand to the respondent.
DEMAND FOR ARBITRATION
DATE_____________________
TO: Name_________________________________________________________
(of party on Whom the Demand is Made)
ADDRESS_________________________________________________________
CITY and STATE____________________________________________________
TELEPHONE ( ) _________________FAX _____________________________
NAME OF REPRESENTATIVE___________________________________________
NAME OF FIRM_____________________________________________________
ADDRESS OF REPRESENTATIVE______________________________________
_________________________________________________________________
TELEPHONE ( )__________________FAX____________________________
The named claimant, a party to an arbitration agreement contained in a written contract, dated__________________and providing for arbitration under the Rules of
Pacific ADR Services hereby demands arbitration thereunder.
THE NATURE OF DISPUTE
Is this claim for the repair, remodel or alteration of a single family residence? _______
THE CLAIM OR RELIEF SOUGHT (the amount, if any)
Types of Business: Claimant___________________________________________
Respondent_______________________________________
You are hereby notified that copies of our arbitration agreement and this demand
are being filed with Pacific ADR Services at its Pasadena office,
with a request that it commence administration of the arbitration.
Under the Rules, you may file an answering statement within ten business days
after notice from the administrator.
Signed_________________________Title________________________________
NAME OF CLAIMANT_________________________________________________
ADDRESS TO BE USED IN THIS CASE___________________________________
__________________________________________________________________
TELEPHONE( )________________FAX________________________________
NAME OF REPRESENTATIVE___________________________________________
NAME OF FIRM______________________________________________________
ADDRESS OF REPRESENTATIVE_______________________________________
__________________________________________________________________
TELEPHONE ( )________________FAX_______________________________
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