Tom Crowley - Hawaii Mediator - Arbitrator - Attorney
Case Submission Form
Date  
eMail
Name
 

I/WE wish to submit the following dispute to ADR HAWAII for:

Mediation Arbitration Med-Arb Other

This case is submitted pursuant to an agreement to submit pending disputes to mediation and/or arbitration. If yes please email or fax us a copy of the agreement.

This case is submitted pursuant to a contract clause.If yes please email or fax us a copy of the contract.


NATURE OF DISPUTE: (Please provide a brief statement of the claim)
Contract:  
Employment
Tort:  
DROA
Family  
Other (Describe below)

We understand that ADR HAWAII will conduct a conflict check and provide us with a Disclosure of Mediator/Arbitrator, and send an Agreement to Engage in Private Mediation/ Arbitration for our review and signature.

List of Parties

CLAIMANT(s):
RESPONDENT(s):
Name of Party
Name of Party
Name of Party's Attorney or Authorized Represent-
ative

Name of Party's Attorney or Authorized Represent-
ative

Address
Address
City
City
State
State
Zip
Zip
Tel
Tel
Fax

Fax

By
By

 

Party 2

Name of Party
Name of Party
Name of Party's Attorney or Authorized Represent-
ative

 
Name of Party's Attorney or Authorized Represent-
ative

 
Address
Address
City
City
State
State
Zip
Zip
Tel
Tel
Fax

Fax

By
By

 

Party 3

Name of Party
Name of Party
Name of Party's Attorney or Authorized Represent-
ative

Name of Party's Attorney or Authorized Represent-
ative

Address
Address
City
City
State
State
Zip
Zip
Tel
Tel
Fax

Fax

By
By

 
Hawaii Honolulu mediator
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