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You can type the information directly into this form. When complete, please print, sign and date it, and then mail to:
ADR Center
CBA Law Center
30 Bank Street 2nd Fl.
New Britain, CT 06051

Commercial/Construction Dispute Resolution Submission Form
Please complete the following:
Date:

Name of Party 1
Street Address
City, State & Zip Code
Telephone                                 Fax
Type of Business (if any)
Name of Attorney or Representative
Name of Firm or Company
Street Address
City, State & Zip Code
Telephone                                 Fax
Signature of Party or Representative
Name of Party 2
Street Address
City, State & Zip Code
Telephone                                 Fax
Type of Business (if any)
Name of Attorney or Representative
Name of Firm or Company
Street Address
City, State & Zip Code
Telephone                                 Fax
Signature of Party or Representative

The parties named above agree to submit this dispute to the American Dispute Resolution Center, Inc (ADR Center).

Procedure Agreed Upon:
 Arbitration Mediation Other
Rules Agreed Upon:
ADR Center Other
Name of Grievant:
Nature of Dispute:
Amount of Claim or Relief Sought:
Location of Hearing:
By signing the above, the parties hereto agree to abide by any arbitration award rendered in this matter.

ADR Center • CBA Law Center • 30 Bank Street - 2nd Fl. • New Britain, CT 06051
phone (860) 832-8060 • fax (860) 223-1846 • www.adrcenter.net