Source: https://www.123contactform.com/form-1225384/Request-For-Mediation-Form-Final-Test
Timestamp: 2017-10-18 00:04:38
Document Index: 377084082

Matched Legal Cases: ['arty 1', 'arty 1', 'arty 1', 'arty 1', 'arty 2', 'arty 2', 'arty 2', 'arty 3', 'arty 3', 'arty 3']

Request for Mediation Form - Form RM
I. PARTY INITIATING MEDIATION (additional initiating parties may be added at the end of Section IV below)
PLEASE PROVIDE THE ADDRESS OF THE PROPERTY THAT IS THE SUBJECT OF THE DISPUTE. THE STREET ADDRESS WILL BE USED TO TRACK YOUR MATTER AND SHOULD BE INCLUDED IN ALL CORRESPONDENCE. THANK YOU.
In the disputed transaction I am the:
Buyer‎ Seller‎ Other‎
If Other, please indicate your role in the dispute:
Email (This will be the primary means of contact for the mediation.)
Will you be represented by legal counsel at the mediation?
If applicable, Counsel Name
Counsel Firm Name
Counsel Address
Please list any dates you WILL NOT be available for a mediation conference during the 60-day period from the date of this request. Please plan to reserve the entire day for the mediation.
Do you have authority to enter into and sign a binding written agreement to settle this dispute?
II. SELECTION OF MEDIATOR
First choice mediator:
Second choice mediator:
Click here to view a list of mediators, their complete profile, and fees. This will open a new window.
Has the Other Party agreed to your proposed mediator? (The parties must jointly agree to a mediator. If No, we will notify the Other Party(ies) of your proposed mediator and work with the parties to identify a mutually acceptable mediator.)
Check here if you would like us to assign a mediator on your behalf. (Selection will be based with consideration of geography, availability and hourly rate whenever possible.)‎
III. DISPUTE SUMMARY
Amount of money involved in the dispute. (Note: matters within the jurisdiction of a small claims court are excluded from the requirement to mediate in standard C.A.R. form agreements. Other exclusions may also apply. Please refer to your agreement to determine any exclusions to the requirement to mediate.)
Please provide a brief description of the dispute. A short description is all that is needed (e.g., deposit dispute, failure to disclose a known defect, landlord-tenant dispute, homeowners&apos; association dispute). You will be given the opportunity to provide further details and a mediation brief directly to your mediator once the mediation is confirmed.
Does The Center have your permission to share the dollar amount and dispute description with the responding party? All other information will be kept confidential.
Will your dispute require an extensive review of documents or briefs by the mediator or was a non C.A.R. standard form used in the transaction that is the subject of the dispute? If yes, the mediator will contact you to discuss any additional mediation fees that may apply for mediation preparation time.
Have formal court proceedings been filed related to the dispute?
Are there any trial dates or time limitations involved?
IV. OTHER PARTY INFORMATION. Please include all parties required to mediate under your agreement. Add non-party interested persons below in Section V. Provide email address and phone contacts whenever available. If contact information is unknown, leave blank or insert "unknown".
Name (Other Party 1)
In the disputed transaction, this party is the:
If Other, please indicate party&apos;s role in the dispute:
Other Party 1 Address
Email (Other Party 1)
Will Other Party 1 be represented by legal counsel at the mediation?
Is there a second Other Party?
Name (Other Party 2)
Other Party 2 Address
Email (Other Party 2)
Is there a third Other Party?
Name (Other Party 3)
Other Party 3 Address
Email (Other Party 3)
If there will be additional parties to the mediation, please provide their name, role and contact information (email & phone) here:
V. OTHER INTERESTED PERSONS INFORMATION (Please list below the names, role and contact information (email & phone) of any relevant individuals NOT required to mediate under your agreement, but whom you intend to invite as voluntary participants to the mediation, and will also be bound by confidentiality pertaining to the mediation. Participation by interested persons should be limited to those helpful to the mediation process and therefore may be limited by the mediator.)
VI. ACKNOWLEDGEMENT OF PROGRAM RULES AND REGULATIONS: By submission of this Request to Mediate, you acknowledge that you have read, understand and agree to the Rules and Policies for Mediation (available at www.car.org/mediation/consumers/consumer-rules). You will receive immediate auto confirmation of receipt of your Request to Mediate via email. You can expect to receive email confirmation of communication with Other Party(ies) or assignment to your selected mediator within two business days following receipt of your request. Please direct any questions by email to mediation@car.org or leave a message at 213-739-8376 and include the street address for the dispute in all correspondence. Thank you.
Click on the Submit button below to submit your Request for Mediation and initiate payment of the non-refundable $300 filing fee.
Submit Request to Mediate