Customer Service 1-800-778-7879 R eq u e s t for www.adr.org A r b i trator S election S e rv i c e s L i s t o n ly date o Construction Does This Filing Involve an Existing AAA Case? o Yes No o Number of Arbitrators on List To Be Provided: o Up to 10 ($1500) o Up to 15 ($2000) Case Type (check one): o Commercial Amount of Enclosed Filing Fee: Desired Qualifications for Arbitrator(s): (Please include information on professional expertise and qualifications desired and geographic limitations and/or locations). TERMINATION OF AAA AUTHORITY Under the “List Only” Arbitrator Selection Service, AAA services conclude with the provision of the arbitrator list. Therefore, AAA services do not include, among other things, the handling of fees charged by the arbitrator(s), inviting arbitrator(s) to serve, performance related matters, disclosure and conflict checks and/or award-related matters. EXCLUSION OF LIABILITY a. The parties agree that neither the AAA nor any arbitrator listed or appointed under this service is a necessary or proper party in judicial proceedings related to either the parties’ arbitration or the provision of services under the AAA’s Arbitrator Selection Services. b. The parties agree that neither the AAA nor any arbitrator listed or appointed under this service shall be liable to any party in any action for damages or injunctive relief for any act or omission in connection with the parties’ arbitration or the provision of AAA’s Arbitrator Selection Services. c. The parties further agree not to call the arbitrator, the AAA or AAA employees as a witness in litigation or any other proceeding relating to the arbitration for which the AAA’s Arbitrator Selection Services have been utilized. The arbitrator, the AAA and AAA employees are incompetent to testify as witnesses in any such proceeding. REFUNDS There is a minimum search fee of $750. If the AAA, in its sole discretion, is unable to compile an appropriate list of arbitrators after completing a search, the balance of the “List Only” Service Fees will be refunded. Please fill out the form on page 2 Request for Arbitrator Selection Services list American LegalNet, Inc. www.FormsWorkFlow.com PAGE 1 Customer Service 1-800-778-7879 R eque s t for www.adr.org A r b i t rato r S e l e ct i o n S e r v i c e s L i s t o n ly ( C ONT ’ D ) REQUESTING PARTY AND REPRESENTATIVE By executing this form below, all parties and their representatives acknowledge that they agree to be bound by the terms of this submission form. Party Nature of Business Party’s Representative Name Firm/Organization Name Address City State Zip Phone Fax Email Signature Additional INFORMATION Dollar Amount of Claim: Dollar Amount of Counterclaim (if any): Nature of Dispute: Reason for Choosing AAA Arbitrator Selection Services: o o o AAA Arbitration Clause in Contract Statutory Requirement to Arbitrate Court Ordered Arbitration o o o Non-AAA Arbitration Clause in Contract Post-Dispute Agreement to Arbitrate Other Request for Arbitrator Selection Services list American LegalNet, Inc. www.FormsWorkFlow.com PAGE 2