Demand For Commercial Arbitration - American Dispute Resolution Center, Inc.

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Name

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Respondent Name*

Type of Business or Occupation*

Street Address*

City, State, & Zip Code*

Telephone*

Email Address*

Name of Attorney or Representative*

Email Address of Attorney or Representative*

Name of Firm or Company*

Attorney/Representative Street Address*

Attorney/Representative City, State, & Zip Code*

Attorney/Representative Telephone*

Claimant Name*

Type of Business or Occupation*

Street Address*

City, State, & Zip Code*

Telephone*

Email Address*

Name of Attorney or Representative*

Email Address of Attorney or Representative*

Name of Firm or Company*

Attorney/Representative Street Address*

Attorney/Representative City, State, & Zip Code*

Attorney/Representative Telephone*

Claimant(s) is a party to a written contract containing an arbitration agreement, dated [field below], which provides for arbitration under the rules of American Dispute Resolution Center, Inc. (ADR Center) and is demanding arbitration as stated.

Contract Date*

Nature of Dispute*

Amount of Claim or Relief Sought*

Location of Hearing (City, State)*

Agreed Upon Rules of Procedure*

ADR Center

Other

Mediation Interest*

I am interested in submitting this matter to mediation. The ADR Center will contact the Respondent(s) to determine if they would agree to attempt mediation prior to arbitration.

Filing Fee Agreement*

By submitting this document, I agree to pay the proper filing fee to the ADR Center.

File

Max. file size: 512 MB.

By submitting this form, parties agree to submit to the rules of the American Dispute Resolution Center, Inc., and to abide by any arbitration award rendered in this matter.