mediation-requests - South Bay Association of Realtors

South Bay Association of REALTORS® Mediation Request

The undersigned party to an agreement, if any contained in a written contract, dated below providing for mediation, hereby consent to mediation under said agreement. *

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Please describe the nature of your dispute: (Required)

Claim or Relief Sought (Amount if any): (Required)

It is understood and agreed that the mediation will be held at the Administrative Office of the South Bay Association of REALTORS®, located at the address below, pursuant to the mediation rules of the Association. A signed copy of the Consent to Mediation and the Mediation Rules and Confidentiality Agreement is necessary to schedule your mediation.

Requesting Party's Contact Information:

Name (Required)

Full Address (Required)

Cell Phone (Required)

Email (Required)

By typing your First and Last Name below, you are agreeing to the Terms and Conditions of the form above (Required)

Date of Signature:

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Representative of Requesting Party (Requesting Party’s Attorney or REALTOR®):

Name (Required)

Representative's Company: (Required)

Cell Phone (Required)

Email (Required)

Other Party’s Contact Information (Please include as much information as possible):

Name (Required)

Full Address (Required)

Cell Phone (Required)

Email (Required)