en-USName: en-USAddress: en-USCity: en-USState: Californiaen-USZip Code: en-USNumber of persons in household: en-USGross monthly income: $ en-USPursuant to section 1284.3 of the California Code of Civil Procedure, consumers with a gross monthly income of less than en-US300% of the federal poverty guidelines, are entitled to a waiver of all fees and costs, exclusive of arbitrator fees. This law en-USapplies to all consumer arbitration agreements subject to the California Arbitration Act, and to all consumer arbitrations en-USconducted in California. If you believe that you meet these requirements, please complete this form and submit it with en-USyour demand for arbitration to the AAA222s Case Filing Services.en-USIf you are not a California consumer you may still apply for a reduction of AAA administrative fees by going to en-USwww.adr.orgen-US or contacting Customer Service (1-800-778-7879 or en-UScustomerservice@adr.orgen-US) and requesting a hardship en-USapplication form.en-USI hereby swear that the foregoing is a true and correct statement.en-USSignature American LegalNet, Inc. www.FormsWorkFlow.com