BTXN 002 (rev. 2/99) UNITED STATES BANKRUPTCY COURT NORTHERN DISTRICT OF TEXAS ALTERNATIVE DISPUTE RESOLUTION SUMMARY 1. 2. 3. 4. 5. Bankruptcy Case No.: ____________________________________________________ Date session(s) held: _____________________________________________________ Duration (i.e., half day, two days): __________________________________________ Your total fee? $ ________________________________________________________ Outcome of ADR (select one): " Parties did not use my services " Settled as a result of ADR " Settled in part as a result of ADR " Parties were unable to reach settlement 6. Provider Please list all persons in attendance (including party association): 7. Please provide the names, addresses, and telephone numbers of counsel on the reverse of this form. Provider Information: Address 8. Signature Date City, State ZIP Phone Suite Provider must file completed form in duplicate with the Bankruptcy Clerk. American LegalNet, Inc. www.FormsWorkFlow.com Please provide the names, addresses, and telephone numbers of counsel in the space provided below. Name Name Firm Name Firm Name Address Address City, State ZIP City, State ZIP Telephone Telephone Name Name Firm Name Firm Name Address Address City, State ZIP City, State ZIP Telephone Telephone Name Name Firm Name Firm Name Address Address City, State ZIP City, State ZIP Telephone Telephone Name Name Firm Name Firm Name Address Address City, State ZIP City, State ZIP Telephone Telephone American LegalNet, Inc. www.FormsWorkFlow.com