Submit a Case The Submitting Party is: Plaintiff Attorney / Plaintiff Defense Attorney / Defendant Legal Assistant PLAINTIFF Plaintiff * Plaintiff's Attorney * (If pro se, put Plaintiff's name.) Plaintiff's Firm * Plaintiff's Attorney's Phone Number * (###) ### #### Plaintiff's Attorney's Email * Legal Assistant Legal Assistant's Email Will a Structured Settlement Broker be attending? If yes, please list in "Other Parties" section * Yes No DEFENDANT Defendant * Client Representative Insurance Company * Defendant's Attorney * Defendant's Firm * Defendant's Attorney's Phone Number * (###) ### #### Defendant's Attorney's Email * Legal Assistant Legal Assistant's Email * OTHER PARTIES Party #3 Name Relationship to case: Party #3 Attorney Party #3 Firm Party #3 Attorney's Phone Number (###) ### #### Party #3 Attorney's Email Party #3 Legal Assistant Party #3 Legal Assistant's Email Party #4 Name Relationship to case: Party #4 Attorney Party #4 Firm Party #4 Attorney's Phone Number (###) ### #### Party # 4 Attorney's Email Party #4 Legal Assistant Party #4 Legal Assistant's Email CASE INFORMATION Service Requested * In-Person Mediation Online Mediation Mediation at My Office Is this a court-ordered mediation? * Yes No Court Case Number (If pre-suit, enter "pre-suit".) Case Name * (If pre-suit, enter "pre-suit".) Have all Parties Agreed to this Procedure? Yes No Comments or Special Instructions Thank you for submitting your case! We will reach out to you shortly.
