AMERICAN ARBITRATION ASSOCIATION
SUPPLEMENTARY PROCEDURES FOR
CONSUMER-RELATED DISPUTES
How to file a claim; consumers should:
• Fill out this form and retain one copy for your records.
•
to:
AAA's Case Filing Services, 1101 Laurel Oak Road
C-8 of the Supplementary Procedures for Consumer-
Related Disputes for the appropriate fee
.
How to file a claim; businesses should
:
• Fill out this form and retain one copy for your records.
• Mail a copy of this form
C-8 of the Supplementary Procedures for Consumer-
Related Disputes for the appropriate fee
.
1
How is this claim being filed? Check only one.
[ ] By request of the consumer (A copy of the arbitration agreement must be attached. A copy of this form must
also be sent to the business)
[ ] By request of the business (A copy of the arbitration agreement must be attached. A copy of this form must
also be sent to the consumer by registered mail return receipt requested)
-or-
[ ] By mutual agreement (“submission”) of the parties (both parties must sign this form)
2
Briefly explain the dispute.
3
Do you believe there is any money owed to you? If yes, how much?
Consumer
______________________________
Address _______________________________________
City/State/Zip___________________________________
Telephone _____________________________________
Fax ___________________________________________
Signature of Consumer ___________________________
Representative __________________________________
Firm __________________________________________
Address _______________________________________
City/State/Zip___________________________________
Telephone _____________________________________
Fax ___________________________________________
Business
Name of Business ___________________________
Address ___________________________________
City/State/Zip_______________________________
Telephone _________________________________
Fax _______________________________________
Signature of Business ________________________
Representative _____________________________
Firm _____________________________________
Address ___________________________________
City/State/Zip_______________________________
Telephone _________________________________
Fax _______________________________________
AAA Case Filing Services 1-877-495-4185
www.adr.org
Mail a copy of this form and your check or money
order made payable to the AAA,
Suite 100, Voorhees, NJ 08043. Please consult Section
and your check or money
order made payable to the AAA, to:
AAA's Case Filing Services, 1101 Laurel Oak Road
Suite 100, Voorhees, NJ 08043. Please consult Section
Name of Consumer
______________________________
Email Address Email Address
_______________________________
______________________________
Email Address Email Address
_______________________________
mail, return receipt requested.
[ ] Yes [ ] No
________________________
• Send a copy of this form to the business.
• Send a copy of this form to the consumer by registered
4
[ ] Yes [ ] No
If yes, what is it?
5
Preferred hearing locale (if an in-person hearing is held) ______________________________________________
Are you seeking any other relief?
6
______________________________________________
Amount enclosed:
7
Fill in the following information:
