Property Address *

Please provide street address, city, state and zip code.

Complainant: Buyer/Seller Name *

Please include full name

Email *

Phone Number *

Complainant: Buyer's/Seller's Real Estate Agent Name *

Please include full name.

Email *

Phone Number *

Respondent: Buyer/Seller Name *

Please include full name.

Email *

Phone Number *

Respondent: Buyer's/Seller's Real Estate Agent Name *

Please include full name.

Email *

Phone Number *

Description of Dispute *

Please provide a brief description of the dispute.

Amount of Money Involved *

Type of Dispute *

Have there been any court pleadings filed in this case? *

Enter required value Yes No

Has a prior agreement to mediate been signed by the parties? *

Enter required value Yes No

Who is requesting mediation? *

Have all parties agreed to mediation? *

Enter required value Yes No

If no, please indicate who has not agreed to mediation

How did you hear about DMAR's Buyer/Seller Dispute Resolution Services? *

Are there any other details you want the mediator to be aware of?