Submit a Case

Demand for Arbitration Form: For arbitrations, please download and complete *the Demand for Arbitration* Form in Adobe PDF or Microsoft® Office Word format. Do not submit arbitration matters electronically. All other cases may be submitted electronically by completing the form below or by downloading and submitting in PDF or Word** format. Name* Title Company Address
City Zip / Postal Code	State / Province Country
Telephone Fax Email Company / Firm Web Address Submitting Party Is If other explain
Case Information Please provide a brief description of the case including issues in controversy or dispute, (i.e.. amount in controversy; relief sought) history and status of settlement discussions, if any, and special information relevant to the choice of ADR process and neutral In Litigation No Yes If yes, please supply case number
Plaintiff/Claimant Information Name Title Company Address
City Zip / Postal Code	State / Province Country
Telephone Fax Email Attorney Representative
Defendant Information Name Title Company Address
City Zip / Postal Code	State / Province Country
Telephone Fax Email Attorney Representative
Defendant Insurance Information Insurance Carrier Name Address
City Zip / Postal Code	State / Province Country
Telephone Fax Handling Claim Representative Claim Number Other Parties to Dispute List Parties Who Have Agreed to Use ADR
Hearing Format Desired Non-Binding/Mediative Processes OR Binding/Adjudicative Processes OR Other
Select JAMS Resolution Center/Hearing Location First Choice Second Choice Third Choice
JAMS Neutral(s) Desired First Choice Second Choice Third Choice Don't know. Please submit names of neutrals suitable for my case. Date Desired Please enter the text in the image below. Text is CaSe SeNsItIvE.*

* Required Field