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Mediation and Arbitration Centre
The Australian Mediation and Arbitration dispute resolution centre
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Online Application
Application Form
Complete this on-line form to request Dispute Resolution Services.
1
Contact
2
Parties
3
Representatives
4
Documents
Contact Name
*
First
Last
Mobile no. (required)
*
Your Email (required)
*
TYPE OF DISPUTE
I need help with a: (choose type of dispute)
*
Specify the nature of your dispute as best you are able, below.
Code of Conduct - industry dispute
Franchising dispute
Commercial contract
Consumer finance
Property dispute
Retail Leasing dispute
Personal injury dispute
Family or Relationship dispute
Farm Debt mediation
Mining Access dispute
Wills or Family Estate
Workplace & Employment dispute
I need a person with the following skills/experience:
*
Select the type of skills the Dispute Resolver needs to have.Unsure of the terms? Go to www.disputeresolution.com.au for a full description.
Mediator
Conciliator
Investigator
Expert Determiner
Arbitrator
PARTY DETAILS
APPLICANT
*
First
Last
RESPONDENT
*
First
Last
Business Name (optional)
Business Name (optional)
Applicant Email (required)
*
Respondent Email (required)
*
Mobile no. (required)
*
Mobile no. (required)
*
Business phone no.
Business phone no.
Applicant Address
Street Address
City
State
Respondent Address
Street Address
City
State
TYPE (select one)
*
Sole Trader
P/L Company
Partnership
Trust
Incorporated Association
No-Liability Company
TYPE (select one)
*
Sole Trader
P/L Company
Partnership
Trust
Incorporated Association
No-Liability Company
REPRESENTATIVES
Applicant's Representative
*
First
Last
Respondent's Representative
*
First
Last
Representative Email (required)
*
Representative Email (required)
*
Mobile no. (required)
*
Mobile no. (required)
*
Office Phone no.
Office Phone no.
Firm Name
Firm Name
Type
*
Business Operator
Agent
Solicitor
Type
*
Business Operator
Agent
Solicitor
INFORMATION
Attach Documents here
Do you have a document that explains the situation or want to send additional material. You can attach a photo in JPEG format or a DOC document or scan to PDF and attach here. Up to 10 separate documents (max 10MB) can be included as attachments.
Drop files here or
Select files
Accepted file types: doc, pdf, jpg, Max. file size: 20 MB, Max. files: 10.
Additional Comments
Add any further information here.
FEES & CONDITIONS
I have read and agree to be bound by the Terms & Conditions for the provision of the Dispute Management Services.
*
YES
NO
Phone
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