CASE TRANSMITTAL FORM
Case Name:
Your Name:
Your Firm:
Telephone:			Fax:
Mailing Address:			Email:
Your Client :				Plaintiff: Defendant:
Other Parties and Representatives:
Name:				Plaintiff: Defendant:
Represented By:
Telephone:			Fax:
Company/Firm:
Mailing Address:
Name:				Plaintiff: Defendant:
Represented By:
Telephone:			Fax:
Company/Firm:
Mailing Address:
Name:				Plaintiff: Defendant:
Represented By:
Telephone:			Fax:
Company/Firm:
Mailing Address:
Type of Case:		Select Category Antitrust Aviation Bad faith Banking Bonds Class action Commercial business Construction Contracts Copyright Corporate and partnership dissolution Discrimination Employment Environmental Fidelity and surety Franchise litigation Insurance coverage International business Legal malpractice Maritime Medical malpractice Personal injury Products liability Professional liability Public policy Real estate Sexual abuse Sexual harassment Unfair competition Wrongful death
Chosen Neutral:
Status of Case:
Latest Demand:		$	Latest Offer:	$
Litigation?:		Yes      No	Key Dates:
Have all other parties agreed to mediation?			Yes      No
Explain:
Fees & Expenses to be paid by:			50/50 Split: Referring party: Other:
Special Instructions/Comments:
Human Verification:

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