Submit a Dispute

(a) If you had a dispute resolution clause in your contract:

Fill out the form (below) and submit the documents with a request to arbitrate/mediate.

(b) If you had no dispute resolution clause in your contract:

Seek the consent of the other party (parties) to submit the dispute to arbitration and/or mediation, and proceed as under (a).

The rules of United ADR apply to all disputes submitted to it; United ADR reserves the right to change these rules from time to time (although not retroactively once a dispute is submitted).

Request to arbitrate/mediate:

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*Indicates required field

Name of party submitting form:*

Party A:*

Party B:*

Type of entity: Type of entity:
Address:*
 Address:*
Country:
 Country:
Phone:*
 Phone:*
Email:*
 Email:*
Website:
 Website:

Method of dispute resolution:
  Arbitrate   Mediate   Other...

Is there an arbitration and/or mediation clause in the agreement between the parties?
  Yes No

If no, in what form have the parties agreed to bring this dispute before "United ADR"?  

Do the parties agree to procedures   on-line  or do you request an  in person hearing(s)?

Briefly describe what the dispute is about:
(If there are more than two parties involved, put additional information here.)

   

Please pay a non-refundable administrative fee of $300.00; if you pay with a different method than credit card, please contact United-ADR. Other payments enter here.