Dispute resolution referral form

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Dispute resolution referral form

Your name * Your address * Your phone * Your e-mail * Other party's name * Other party's address * Other party's phone * Please select the type of dispute for which you request assistance.

Between employee and manager/supervisor/companyBetween co-workersBetween neighborsBetween customer and merchantOther (please describe below)Other dispute (please describe)Briefly explain why you are requesting our services* denotes required field

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NOTE: A request for mediation services is not a guarantee. Both parties must agree to mediation before services can be rendered.

If you encounter difficulty with this form or have questions about submitting a referral request, please call 704-336-2903 or e-mail Donna Sullivan.

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