Request for Alternative Dispute Resolution (ADR)

Contact Information of the Person Requesting (ADR)

(All fields are required in this section)

Name: Address: City : State: Zip Code: Email Phone:

Information Required to Proceed with ADR

Confirmation that All Parties Agree to Proceed with ADR (Yes or No):

(If all party agreement is not obtained before requesting ADR, the request will likely be denied)

Optional Addition Information Concerning your Case (If Known)

(All fields are optional in this section. Please complete the information as best as you can, then click on the SUBMIT button below to submit your request.)

Proceeding Name: Is this a pre-filing?: Proceeding Number Case Summary: Summary of Disputed Issue(s): All Party Names, Emails, and other Contact Info: Assigned ALJ / Commissioner: Desired ADR Timeframe: Desired ADR Location (Sacramento, San Francisco, Los Angeles, etc.) Any Other Relevant Information:

Request for Alternative Dispute Resolution

Request for Alternative Dispute Resolution (ADR)

Contact Information of the Person Requesting (ADR)

Information Required to Proceed with ADR

Optional Addition Information Concerning your Case (If Known)

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