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Request For Mediation (International) - Official Federal Forms
| Request For Mediation (International) Form. This is a national form and can be used in International Centre For Dispute Resolution American Arbitration Association . |
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INTERNATIONAL CENTRE FOR DISPUTE RESOLUTION The International Division of the American Arbitration Association REQUEST FOR MEDIATION Date: To: Name (of the party on which the request is to be served) Address: City: Telephone: Name of Representative: (if known) Address: City: Telephone: State/Province: Facsimile: Country: Email: Post Code: State/Province: Facsimile: Country: Email: Name of Firm: (if applicable) Post Code: Nationality: The undersigned party to an agreement contained in a written contract, dated the International Dispute Resolution Procedures Commercial Arbitration Rules and Mediation Procedures (AAA) Other (please specify): hereby requests mediation. Nature of the Dispute: (attach additional sheets, if necessary) Type of Business: Filing Party Place of Mediation Requested: Responding Party providing for mediation under You are hereby notified that copies of our MEDIATION agreement and this REQUEST are being filed with the INTERNATIONAL CENTRE FOR DISPUTE RESOLUTION at Case Filing Services, 1101 Laurel Oak Road, Suite 100, Voorhess, NJ 08043 email: casefiling@adr.org, with a request that it commence administration of the mediation. Name of Filing Party: Address: (to be used in connection with this case) City: Telephone: Name of Representative: (if known) Address: City: Telephone: State/Province: Facsimile: Country: Email: Post Code: State/Province: Facsimile: Country: Email: Name of Firm: (if applicable) Post Code: Nationality: To begin proceedings, please send two copies of this request and the Mediation Agreement, with the filing fee as provided for in the rules, to the ICDR. Send the original request to the responding party. Signature (may be signed by a representative) Title: Date: If you have any questions, please contact the International Centre for Dispute Resolution at 1.888.855.9575 or +1.212.484.4181 or visit our website at www.icdr.org. American LegalNet, Inc. www.FormsWorkFlow.com
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