MEDIATION
Divorce
Legal Separation
Family
WORKPLACE
  
  Management

  Employment
CONTRACT

   Business
  Real Estate

MEDIATORS
Oliver Ross JD, PhD
Suzette Pintard, JD

MEDIATION
TRAINING

Divorce and Family
Workplace
Management

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DISPUTE RESOLUTION SYSTEM

REQUEST TO INITIATE MEDIATION - TRANSMITTAL FORM

To E-Mail press the "submit"  button at the bottom of this page. To fax or mail, print this form.

 

DATE:     

1. PARTY REQUESTING MEDIATION Please provide your:

Name:        
Phone #: 
Fax:          
Address: 

Buyer

Seller

Broker

Sales Agent

Builder/contractor

Other

If you have legal or other counsel in this matter, 
provide:   
 Name :        
Telephone:
 Address:   


2. OTHER PARTY(S) TO BE INCLUDED IN MEDIATION 
(Include any party whose attendance at the mediation would be 
necessary or helpful in resolving the dispute)

Name:       
Phone #:
Fax:         
Address:

Buyer

Seller

Broker

Sales Agent

Builder/contractor

Other

If this party has legal or other counsel in this matter, 
provide: 
 Name :        
Telephone:
 Address:    


Name:       
Phone #:
Fax:       
Address:

Buyer

Seller

Broker

Sales Agent

Builder/contractor

Other

If this party has legal or other counsel in this matter, 
provide: 
 Name :      
Telephone:
 Address:  


3. BRIEF DESCIPTION OF CLAIM:


4. AMOUNT OF MONEY INVOLVED:$ 


5. COURT PROCEEDINGS
The standard form Arizona Association of REALTORS® Residential Purchase Contract, at lines 365-374, requires mediation before resort to most court proceedings. However, if any formal court proceedings have been filed in this matter, provide: 
Name of party who commenced court proceedings: 
Court case#:                             
Name, address and telephone number of legal counsel, if any:



6.  DISPUTE RESOLUTION SYSTEM LIAISON

The original of this form, along with a non-refundable $95 deposit, should be mailed, faxed or submitted to:
Out-of-Court Solutions
4545 E. Shea Blvd., Suite 205
Phoenix, AZ 85028 
Phone (602) 404-1500, Fax (602) 404-1515

A copy of this form should be mailed to: 
Dispute Resolution System Liaison

Arizona Association of REALTORS®, 
255 E. Osborn Rd., Suite 200, 
Phoenix, AZ 
85012.

(We will process your Request upon receipt of your deposit, which will be applied to your one-half of the hourly mediation fee of $190.00)

CREDIT CARD #                
                                                                                                  ACCEPTED ONLY

EXP. DATE
BILLING ADDRESS: