DMA Dispute Management & Avoidance

the comprehensive litigation alternative




Name_____________________________________

Address___________________________________

City, State & Zip___________________________

Home Phone_______________________________

Office Phone______________________________

Cell Phone________________________________

Fax_______________________________________

E-Mail____________________________________

Name_____________________________________

Address___________________________________

City, State & Zip___________________________

Home Phone_______________________________

Office Phone______________________________

Cell Phone________________________________

Fax_______________________________________

E-Mail____________________________________

Herein after known as

CLAIMANT

Herein after known as

RESPONDENT

Signature________________________________ Date____________________________________

Signature________________________________ Date____________________________________

Address__________________________________ City State & Zip__________________________

Jobsite Phone____________________________

Herein after known as

JOBSITE

The parties as listed above, hereby jointly agree to Arbitrate their dispute and submit the following issue(s) to binding On Site Arbitration pursuant to the Rules and Procedures of DMA Dispute Management & Avoidance, which shall act as tribunal.

CLAIM BY CLAIMANT

Describe the nature of the dispute, attach additional sheets as necessary:

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CLAIM OR RELEIF SOUGHT BY CLAIMANT

Describe the claim (dollar amount) or remedy sought (action):

_________________________________________________________________________________________________________

SUBMISSION TO ARBITRATION

COUNTER-CLAIM BY RESPONDENT

Describe the nature of the dispute, attach additional sheets as necessary:

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

COUNTER-CLAIM OR RELEIF SOUGHT BY RESPONDENT

Describe the claim (dollar amount) or remedy sought (action):

_________________________________________________________________________________________________________

Please submit your entire evidence package with this document pursuant to section 13.3 of the Rules and Procedures, & mail to: 800 South P.C.H. Suite 8-281, Redondo Beach, CA 90277

We agree that the Arbitrators decision shall be binding.  We shall abide by and perform any Award rendered hereunder and that a civil judgement may be entered upon the Award.

CLAIMANT

RESPONDENT

Signature________________________________ Date____________________________________

Signature________________________________ Date____________________________________