APPLICATION FOR ARBITRATION EASTERN DISTRICT OF TENNESSEE STYLE OF CASE__________________________________ v. _________________________________________ DOCKET NO. _________________________________________ TYPE OF CASE _______________________________________ (Indicate number from Item V, "Nature of Suit," from the Civil Cover Sheet, Form JS 44.)INFORMATION ABOUT 1ST PARTY: NAME:______________________________________________________________________________________ First Middle LastSTREET ADDRESS:___________________________________________________________________________ CITY, STATE, ZIP CODE:______________________________________________________AGE:___________ HOME PHONE:__________________________________ WORK PHONE:______________________________ ATTORNEYS NAME:_____________________________WORK PHONE:______________________________ Please identify the principals for any closely held corporation, identify all partners of a general partnership, identify the general partner of anylimited partnership and all principals of any limited liability company involved in the arbitration. ____________________________________________________________________________________________ ____________________________________________________________________________________________ INFORMATION ABOUT 2ND PARTY: NAME:______________________________________________________________________________________ First Middle LastSTREET ADDRESS:___________________________________________________________________________ CITY, STATE, ZIP CODE:_____________________________________________________AGE:__________ HOME PHONE:___________________________________ WORK PHONE:_____________________________ ATTORNEYS NAME:______________________________WORK PHONE:_____________________________ Please identify the principals for any closely held corporation, identify all partners of a general partnership, identify the general partner of anylimited partnership and all principals of any limited liability company involved in the arbitration. ____________________________________________________________________________________________ ____________________________________________________________________________________________ (continued) >>>> 2PLEASE PROVIDE INFORMATION ON ANY OTHER PARTIES INVOLVED IN THIS ARBITRATION: (Use back side of form if more room is needed.) NAME:______________________________________________________________________________________ First Middle LastSTREET ADDRESS:___________________________________________________________________________ CITY, STATE, ZIP CODE:______________________________________________________________________ HOME PHONE:_______________________________________ WORK PHONE:_________________________ ATTORNEYS NAME:__________________________________WORK PHONE:________________________ Please identify the principals for any closely held corporation, identify all partners of a general partnership, identify the general partner of any limitedpartnership and all principals of any limited liability company involved in the arbitration . ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________WE HAVE SELECTED THE FOLLOWING ARBITRATOR: ________________________________________ ____________________________________________________________________________________________ Signature and Printed Name of Attorney For One of the Parties Date PLEASE SUBMIT THIS FORM TO THE OFFICE OF THE CLERK IN THE DIVISION WHERE THE CASE IS FILED.