VOLUNTARY BINDING ARBITRATION PROGRAM APPLICATION County Case Caption: Docket No: Attorneys: Plaintiff: Defendant: Other: Panel selected to decide case: Plaintiff: Defendant: Estimated time to present the case: Issue(s) to be submitted for decision: hours Phone: Phone: vs. Type of case: Phone: Phone: Phone: Have you agreed on a high/low range? If so, state: the high limit $ Yes the low limit $ Yes Yes Yes No Is the panel to be advised of the high/low limits? Is testimony to be presented? Will cross examination be permitted? No No No No Will prejudgment interest be calculated on the award? Yes State any stipulations of facts or other agreements on attached sheet. Date of Application: We agree to submit the foregoing case to a binding, non-appealable decision by the above named panel and have the authorization of our clients to do so. We hereby certify that all discovery is complete and this matter is ready to be submitted to arbitration. Attached is a consent order of dismissal with prejudice. Attorney for plaintiff: Attorney for defendant(s): (submit completed form to the arbitration administrator and a hearing will be scheduled) American LegalNet, Inc. www.FormsWorkflow.com