S U B M I S S I O N F O R N O N - B I N D I N G B U S I N E S S & C O N S U M E R A R B I T R AT I O N Thank you for agreeing to participate in a non-binding arbitration provided by the American Arbitration Association®. Please provide the requested information so that we can initiate your arbitration proceeding with the other party. This form may be used either in a consumer-business dispute or in a business to business dispute. After filing, you and the other party will receive information from the AAA® case manager assigned to your case. The Non-Binding Arbitration Rules for Consumer Disputes and Business Disputes describe the steps that will follow our initiation of your case. Date: Request for Non-Binding Arbitration Required by Contract Clause Notice to Respondent Regarding Request for Arbitration Required by Contract Between Two Parties: Claimant, a party to an arbitration agreement or program which provides for arbitration under the AAA Non-Binding Rules for Consumer Disputes and Business Disputes, hereby demands and submits this dispute to arbitration. You are hereby notified that a copy of the Arbitration Clause in our Agreement and this demand form are being filed with the American Arbitration Association, with a request that it commence administration of the arbitration. Under the AAA’s Non-Binding Arbitration Rules for Consumer Disputes and Business Disputes, you may file an answering statement within fifteen days after notice from the AAA. Submission for Non-Binding Arbitration of a Dispute Between a Business and a Consumer Notice to Filing Party (Claimant) Regarding Submission to Arbitration: To begin proceedings, please send a copy of this Demand notice and the Arbitration Clause in your Agreement, along with the filing fees provided for in the Non-Binding Rules for Consumer Disputes and Business Disputes, to the AAA at 1101 Laurel Oak Road, Suite 100, Voorhees, NJ 08043. Under the AAA rules, if Respondent fails to participate in a contractually required non-binding arbitration, the AAA will administratively close the case and advise the parties that it is concluded and that they may proceed with other resolution options. Filing Party Name (Claimant) Filing Party’s Representative (if different) Business/Firm (if any) Business/Firm (if any) Address Address City Phone State Zip City Fax State Phone Email Zip Fax Email Name And/Or Signature Of Party Executing This Form Case Filing Services 1-877-495-4185 www.adr.org American LegalNet, Inc. www.FormsWorkFlow.com S U B M I S S I O N F O R N O N - B I N D I N G B U S I N E S S & C O N S U M E R A R B I T R AT I O N page 2 Responding Party Name (Respondent) Responding Party’s Representative (if different) Business/Firm (if any) Business/Firm (if any) Address Address City State Phone Email Zip Fax City State Phone Zip Fax Email Please tell us about the dispute between you and the other party. You may attach additional pages as needed. Amount in Dispute: Requested by: Hearing Location—In most instances, a non-binding arbitration under the AAA Non-Binding Arbitration Rules will be by documents only, but may include a telephonic hearing among the parties and arbitrator, for the convenience of all. However, where an in-person hearing is to be held, we need to know the locale requested:_______________________________ Is there a locale for hearings provided for in an arbitration agreement between the parties and if so, what is that locale: Please send the original copy of this Submission to the Respondent (Party you are filing against). Case Filing Services 1-877-495-4185 www.adr.org American LegalNet, Inc. www.FormsWorkFlow.com