Community Mediation Website Inquiry Intake

Community Mediation Inquiry
Is this dispute related COVID19?
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you representing a business?
Business Name:
Email
example@example.com
Best Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What is the best way to contact you?
Have you ever used our mediation services before?

Other Party: Enter the information for the other side you are in dispute with.
Is the other side a business?
Business Name:
Name (Point of Contact)

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
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?
Court Case Number
Court Hearing Date

MonthDayYear
Date
Does this matter involve an "Eviction" Notice or Unlawful Detainer (Summons and Complaint)?
Should be Empty:

Community Mediation Inquiry