DEMAND FOR ARBITRATIONCONSUMER ARBITRATION RULES
Complete this form to start arbitration under an arbitration agreement in a contract.
1. Which party is sending in the filing documents? (check one)

ConsumerBusiness

2. Briefly explain the dispute:

3. Specify the amount of money in dispute, if any: $4. State any other relief you are seeking:Attorney Fees

Interest

Arbitration Costs

Other; explain:

5. Identify the requested city and state for the hearing if an in-person hearing is held:
State: Select...

City:

District
DelawareConnecticut
Colorado
CaliforniaArkansas
Arizona
AlaskaAlabama
NevadaNebraska
Montana
MissouriMississippi
Minnesota
Michigan
Massachusetts
Maryland
Maine
Louisiana
KentuckyKansasIowa
Indiana
Illinois
Idaho
HawaiiGeorgia
FloridaNewNorth
Rhode
Pennsylvania
OregonOklahoma
Ohio
South
West
Washington
Virginia
Vermont
Utah
Texas
Tennessee
Wyoming
Wisconsin
Hampshire
JerseyMexicoYork
Virginia
Carolina
DakotaCarolina
DakotaIslandof Columbia

6. Please provide contact information for both the Consumer and the Business. Attach additional sheets or forms as needed.
Consumer:
Name:
Address:
City:

State: Select...

Telephone:

Fax:

District
DelawareConnecticut
Colorado
California
Arkansas
Arizona
AlaskaAlabama
NevadaNebraska
Montana
MissouriMississippi
Minnesota
Michigan
Massachusetts
Maryland
Maine
Louisiana
KentuckyKansasIowa
Indiana
Illinois
Idaho
HawaiiGeorgia
Florida
New
North
Rhode
Pennsylvania
OregonOklahoma
Ohio
South
West
Washington
Virginia
Vermont
Utah
Texas
Tennessee
Wyoming
Wisconsin
Hampshire
JerseyMexicoYork
Virginia
Carolina
DakotaCarolina
DakotaIslandof Columbia

Zip Code:

Email Address:
Consumer’s Representative (if known):
Name:
Firm:
Address:
City:

State: Select...

Telephone:Fax:

District
DelawareConnecticut
Colorado
California
Arkansas
Arizona
AlaskaAlabama
NevadaNebraska
Montana
MissouriMississippi
Minnesota
Michigan
Massachusetts
Maryland
Maine
Louisiana
KentuckyKansasIowa
Indiana
Illinois
Idaho
HawaiiGeorgia
FloridaNewNorth
Rhode
Pennsylvania
OregonOklahoma
Ohio
South
West
Washington
Virginia
Vermont
Utah
Texas
Tennessee
Wyoming
Wisconsin
Hampshire
JerseyMexicoYork
Virginia
Carolina
DakotaCarolina
DakotaIslandof Columbia

Zip Code:

Email Address:
Business:
Name:
Address:
City:

State: Select...

Telephone:

Fax:

District
DelawareConnecticut
ColoradoCalifornia
Arkansas
Arizona
AlaskaAlabama
NevadaNebraska
Montana
MissouriMississippi
Minnesota
Michigan
Massachusetts
Maryland
Maine
Louisiana
KentuckyKansasIowa
Indiana
Illinois
Idaho
HawaiiGeorgia
FloridaNewNorth
Rhode
Pennsylvania
OregonOklahoma
Ohio
South
West
Washington
Virginia
Vermont
Utah
Texas
Tennessee
Wyoming
Wisconsin
Hampshire
JerseyMexicoYork
Virginia
Carolina
DakotaCarolina
DakotaIslandof Columbia

Zip Code:

Email Address:

American Arbitration Association, Case Filing Services, 1101 Laurel Oak Road, Suite 100, Voorhees, NJ 08043
https://www.adr.org | AAA Customer Service 1-800-778-7879

DEMAND FOR ARBITRATIONCONSUMER ARBITRATION RULES

Business’ Representative (if known):
Name:
Firm:
Address:
City:

State: Select...

Telephone:

Fax:

District
DelawareConnecticut
Colorado
California
Arkansas
Arizona
AlaskaAlabama
NevadaNebraska
Montana
MissouriMississippi
Minnesota
Michigan
Massachusetts
Maryland
Maine
Louisiana
KentuckyKansasIowa
Indiana
Illinois
Idaho
HawaiiGeorgia
Florida
New
North
Rhode
Pennsylvania
OregonOklahoma
Ohio
South
West
Washington
Virginia
Vermont
Utah
Texas
Tennessee
Wyoming
Wisconsin
Hampshire
JerseyMexicoYorkVirginia
Carolina
DakotaCarolina
DakotaIslandof Columbia

Zip Code:

Email Address:
Date:

7. Send a copy of this completed form to the AAA together with:• A clear, legible copy of the contract containing the parties’ agreement to arbitrate disputes;• The proper filing fee (filing fee information can be found in the Costs of Arbitration section of the Consumer Arbitration Rules); and• A copy of the court order, if arbitration is court-ordered.
8. Send a copy of the completed form and any attachments to all parties and retain a copy of the form for your records.
To file by mail, send the initial filing documents and the filing fee to: AAA Case Filing Services, 1101 Laurel Oak Road, Suite 100,Voorhees, NJ 08043.
To file online, visit www.adr.org and click on File or Access Your Case and follow directions. To avoid the creation of duplicate filings,
the AAA requests that the filing documents and payment be submitted together. When filing electronically, no hard copies are required.

Pursuant to Section 1284.3 of the California Code of Civil Procedure, consumers with a gross monthly income of less than 300% of
the federal poverty guidelines are entitled to a waiver of arbitration fees and costs, exclusive of arbitrator fees. This law applies to all
consumer agreements subject to the California Arbitration Act, and to all consumer arbitrations conducted in California. If you believethat you meet these requirements, you must submit a completed Affidavit for Waiver of Fees, available on our website.

American Arbitration Association, Case Filing Services, 1101 Laurel Oak Road, Suite 100, Voorhees, NJ 08043
https://www.adr.org | AAA Customer Service 1-800-778-7879