Submitting Party*
Submitting Parties Telephone Number* ( )
Type of Case:
Appellate Bad Faith / Insurance Coverage Business/Contract Law Class Actions Complex Litigation Construction Defect Disability/Access Discovery Elder Care Law Eminent Domain Employment Law Entertainment Law Environmental Issues Family Law / Cooperative Divorce Federal Disputes Fee Disputes Governmental Entities Homeowners Associations Intellectual Property Legal Malpractice Lender Liability Medical Malpractice Personal Injury Premises Liability Probate Disputes Products Liability Professional Liability Real Estate Transportation
Mediation Binding Arbitration Discovery Referee Private Trial / §638 Reference Judge Pro Tem Settlement Conference Settlement Days Appellate Review Arbitration Tribunaal Low-Cost Mediation & Arbitration Services Cooperative Divorce Center Neutral Fact Finding Early Neutral Evaluation Complex Case Management Services
Have you selected an ARC Neutral (Check if yes )
If yes who?
Attorney for Plaintiff/Claimant
Firm Street Address City Zip Phone ( ) Fax
Secretary's Name
Attorney for Defendant/Respondant
Additional Attorney
INSURANCE CLAIM INFO, if applicable:
Name of Insured Claim Number Insurance Carrier Date of Loss Claims Representative Street Address City Zip Phone ( ) Fax
Estimated Preparation/ Hearing Time