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Is this case pending in court?
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Mediation Arbitration
Name of Party Submitting Request:
First Name:
Last Name:
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Home Phone:
Work Phone:
Email:
Do the other parties know you would like to mediate?
yes No
Are the other parties willing to mediate?
yes No
  • Name of additional Parties:
Name of First Party submitting Request:
First Name:
Last Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Email:
Name of Second Party submitting Request:
First Name:
Last Name:
Address:
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State:
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What are the issues in the case? (ex: divorce = child support / custody / division of property)
** please DO NOT list specifics to your case, just the basics.
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Would You Like to set up a telephone consultation?
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When is a good time to reach you?