SUBMISSION TO DISPUTE RESOLUTION Please visit our website at www.adr.org if you would like to file this case online. AAA Customer Service can be reached at 800-778-7879. The named parties hereby submit the following dispute for resolution, under the rules of the American Arbitration Association. To be completed and signed by all parties (attach additional sheets if necessary). Rules Selected: Commercial Procedure Selected: Construction Binding Arbitration Employment Mediation Other: (please specify) Other: (please specify) Nature of Dispute: Other Relief Sought: Dollar Amount of Claim: $ Attorneys Fees Interest Punitive/Exemplary Arbitration Costs Other Please Describe Appropriate Qualifications for Arbitrator(s) to be appointed to hear this Dispute: Amount Enclosed: $ In accordance with Fee Schedule: Flexible Fee Schedule Standard Fee Schedule Estimated Time Needed for Hearings Overall: Hearing Locale Requested: hours or days We agree that, if arbitration is selected, we will abide by and perform any award rendered hereunder and that a judgment may be entered on the award. Name of Party: Name of Party: Address: Address: City: State: Phone No.: Zip Code: Fax No.: City: State: Phone No.: Fax No.: Email Address: Email Address: Signature (required): Signature (required): Date: Date: Name of Representative: Name of Representative: Name of Firm (if applicable): Name of Firm (if applicable): Address (to be used in connection with this case): Zip Code: Address (to be used in connection with this case): City: State: Phone No.: Fax No.: Email Address: Zip Code: City: State: Phone No.: Zip Code: Fax No.: Email Address: To begin proceedings, please send a copy of this Demand and the Arbitration Agreement, along with the filing fee as provided for in the Rules, to: American Arbitration Association, Case Filing Services, 1101 Laurel Oak Road, Suite 100, Voorhees, NJ 08043. Send the original Demand to the Respondent. American LegalNet, Inc. www.FormsWorkFlow.com