American Arbitration Association SUBMISSION TO RESOLUTION SERVICES The named parties hereby submit the following dispute for resolution, under the rules of the American Arbitration Association: Procedure Selected: Binding Arbitration Mediation Fact-Finding Other (describe) Early Neutral Evaluation Mini-Trial Rules to Apply: Commercial International Other (describe) Construction Employment Nature and Type of Dispute (attach additional sheets if necessary): Amount of Monetary Claim or Nature of Non-Monetary Claim: Type of Business: Claimant: Place of Hearing or Conference: 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. To be completed and signed by all parties (attach additional sheets if necessary, please remember to obtain signatures) _________________________________________ Name of Party Address Respondent: __________________________________________ Name of Party _________________________________________ _________________________________________ __________________________________________ Address __________________________________________ City, State and Zip Code City, State and Zip Code ( ____ ) _______________________________________ Telephone Email address Fax ( ___ ) ____________________________________ Telephone Fax _______________________________________________ Email address ______________________________________________ ______________________________________________ Name of the Party's Attorney or Representative __________________________________________ Name of the Party's Attorney or Representative ______________________________________________ Name of Firm (if applicable) __________________________________________ Name of Firm (if applicable) ______________________________________________ Address __________________________________________ Address ______________________________________________ City, Sate and Zip Code __________________________________________ City, Sate and Zip Code ( ____ ) _______________________________________ Telephone Fax ___________________________________________________ Email address ( ___ ) ____________________________________ Telephone Fax _______________________________________________ Email address ______________________________________________ Signed (may be signed by a representative) Title Date: ___________________________ ______________________________________ Signed (may be signed by a representative) Title Date: ____________________________ Please file two signed copies and the non-refundable filing fee with the AAA. For additional information, please visit our website at www.adr.org SIGNATURES OF ALL PARTIES ARE REQUIRED. Form SRS 6/05 American LegalNet, Inc. www.USCourtForms.com