012

FORM 12.

American Arbitration Association Commercial Arbitration Rules Demand for Arbitration

Date: _________________ TO:

(Name) _________________________________________ (of party upon whom the Demand is made) (Address) ________________________________________ (City and State) ______________________ (Zip Code) ______ (Telephone) _______________________________________

Named claimant, a party to an arbitration agreement contained in a written contract, dated ___________________, providing for arbitration, hereby demands arbitration thereunder. (attach arbitration clause or quote hereunder) SAMPLE ARBITRATION CLAUSE: Any controversy or claim arising out of or relating to this contract, or any breach thereof, shall be settled in accordance with the Rules of the American Arbitration Association, and judgment upon the award may be entered in any court having jurisdiction thereof. NATURE OF DISPUTE: CLAIM OR RELIEF SOUGHT: (amount, if any) TYPE OF BUSINESS: Claimant _________________________

Respondent ______________________

HEARING LOCALE REQUESTED: _________________________________________ City and State)

(

You are hereby notified that copies of our arbitration agreement and of this demand are being filed with the American Arbitration Association at its ________________ Regional Office, with the request that it commence the administration of the arbitration. Under Section 7 of the Commercial Arbitration Rules, you may file an answering statement within seven days after notice from the Administrator. Signed ____________________________ Title __________________________ (May Be Signed by Attorney) Name of Claimant ______________________________________ Home or Business Address of Claimant ______________________________________ City and State ________________________ Zip Code _______ Telephone ______________________________________ Name of Attorney ______________________________________ Attorney's Address ______________________________________ City and State ________________________ Zip Code _______ Telephone ______________________________________

--Author's Note: To institute proceedings, send three copies of this Demand with the administrative fee, as provided in Section 48 of the Rules, to the AAA. Send original Demand to Respondent.