Community Mediation Website Inquiry Intake

Community Mediation Inquiry
Is this dispute related COVID19?*

YesNo
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you representing a business?*

YesNo
Business Name:
Email*
example@example.com
Best Contact Phone Number*
Please enter a valid phone number.
What is the best way to contact you?*

EmailPhone
Have you ever used our mediation services before?*

1st Time ClientRepeat Client

Other Party: Enter the information for the other side you are in dispute with.
Is the other side a business?*

YesNo
Business Name:
Name (Point of Contact)*

First NameLast Name
I know the following information about the other party (Multiple Selections OK):*

AddressPhone NumberEmailI do not have contact information for the other side.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
NOTE: Without any contact information for the other side, the Center for Conflict Resolution will not be able to begin the mediation process. Once you are able to provide that information, we can assist you further with your dispute.

Please describe the facts of this dispute (names, events, dates, etc.):*
Note: This information may be shared with the other side.
What settlement discussions have occurred in the past?
Is this matter related to a court case?*

YesNo
Court Case Number
Court Hearing Date

MonthDayYear
Date
Does this matter involve an "Eviction" Notice or Unlawful Detainer (Summons and Complaint)?*

YesNo
Should be Empty:

Community Mediation Inquiry