STATE OF NORTH CAROLINA County Name Of Plaintiff(s) File No. In The General Court Of Justice District Court Division Name Of Defendant(s) VERSUS STIPULATION AND ORDER ARBITRATION G.S. 7A-37.1; Rules For Court-Ordered Arbitration In North Carolina The parties STIPULATE that all issues in the above-entitled action may be submitted to arbitration pursuant to the Rules For Court-Ordered Arbitration in North Carolina. The arbitrator's award shall be Date binding non-binding upon the parties. (see note below) The parties will be ready for a hearing by this date: (must be held within sixty (60) days of filing of last responsive pleading) court approval. See Rules For Court-Ordered Arbitration in North Carolina. If there are none, write "none" in space below.) The following special conditions and modifications of the arbitration rules are agreed upon, subject to court approval: (INSTRUCTION: Specify any special conditions or modifications of the arbitration rules you have agreed upon for which you seek Date Signature Date Signature Attorney For Plaintiff(s) Plaintiff(s) Attorney For Defendant(s) Defendant(s) ORDER It is ORDERED that this case be scheduled for an arbitration hearing to be scheduled by the Court and conducted in compliance with the Rules For Court-Ordered Arbitration In North Carolina. Special conditions and modifications as requested are approved by the Court. Date Name Of Judge (Type Or Print) Signature Of Presiding Judge NOTE: If you check the box marked "binding," you will be giving up your right to have your case tried by a judge or jury in the event that you disagree with the arbitrator's award. If you do not check either box, your award will be treated as non-binding. AOC-CV-912M, Rev. 2/12 © 2012 Administrative Office of the Courts Original - File Copy - Scheduling Copy-Plaintiff Copy - Defendant American LegalNet, Inc. www.FormsWorkFlow.com