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Submit A Case

Demand for Arbitration Form:
For arbitrations, please download and complete
in Adobe PDF or Microsoft® Office Word format.
Do not submit arbitration matters electronically.

All other cases may be submitted electronically by completing the form below
or by downloading and submitting in PDF or Word format.

Name:  
Title:  
Company/Firm Name:  
Address:  
City:   State:   Zip:  
Country:  
Telephone:  
Fax:  
E-Mail Address:  
Company/Firm's Web address (URL):  
Submitting party is:  
If other, explain:  

Case Information
Please provide a brief description of the case including issues in controversy or dispute, (i.e.. amount in controversy; relief sought) history and status of settlement discussions, if any, and special information relevant to the choice of ADR process and neutral.
In litigation:   Yes No
If yes, supply case number:  


Plaintiff/Claimant Information

Name:  
Title:  
Company/Firm Name:  
Address:  
City:   State:   Zip:  
Country:  
Telephone:  
Fax:  
E-Mail Address:  
Attorney Representative:  


Defendant Information

Name:  
Title:  
Company/Firm Name:  
Address:  
City:   State:   Zip:  
Country:  
Telephone:  
Fax:  
E-Mail Address:  
Attorney Representative:  


Defendant Insurance Information


Insurance Carrier Name (if any):  

Address:  
City:   State:   Zip:  
Country:  
Telephone:  
Fax:  
Handling Claim Representative:  
Claim Number:  

Other Parties to the Dispute

List Parties Who Have Agreed to Use ADR

Hearing Format Desired
Non-Binding/Mediative Processes:  
OR
Binding/Adjudicative Processes:  
OR
Other:  

Select JAMS Resolution Center/Hearing Location
1st Choice:  
2nd Choice:  
3rd Choice:  

JAMS Neutral(s) Desired
1st Choice: