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  Services ~ Mediation Services >               Submit a Case - Form

Fill out the form below to begin the process of resolving your dispute ~
Fees are negotiated between participants and Mediator

Your Company Name: 
Your Name:
Email address:
Phone Number:
Please enter your company's  or  your home address.
If you do not wish for the mediator to contact the other party, please leave this section blank.

1. Please Fill out the other party's basic information.

Party's Company Name: 
Party's  Name:
Email address:
Phone Number:
Are there other parties involved in this disputes?

If so, list their names and email addresses. (one per line)


2. Please fill out these dispute details:
Nature of the dispute:

What date did this dispute begin?

What is the approximate monetary value of the items under dispute?
3. This dispute is regarding.

4. What has happened so far in this dispute? (phone calls, emails, etc.)

5. What do you and the other party disagree about?

6. Are there any things you and the other party might agree upon?

7. What do you want to get from this mediation?

8. Are there any attorney representation from either side? If Yes, please provide their names and email addresses (one per line)

9. What location (mediater's office or neutral location), in your judgment will be best suitable to hold mediation sessions? 

10. How soon do you want to resolve this dispute?

11. Anything else you think it would be helpful for a mediator to know.