To submit a case for mediation, please complete the following form or contact us.

After receiving the case submission form, each party will then be sent explanatory materials and preliminary documents.  USA&M obtains the parties’ agreement to arbitrate and provides the arbitrator and the venue.  

We structure our process to facilitate closing files, not to increase your workload. 

Feel free to contact us with any questions you may have.

All fields for Parties 1 & 2 are required.
Fields for Parties 3 through 8 are only required if three or more parties are participating in the arbitration.

Arbitration Case Submission Form (Adobe® Acrobat Required, get it here)

Party 1

Party 1 Full Name
Party 1 Role	choose a role Claimant Respondent Claimant/CounterRespondent Respondent/CounterClaimant CounterRespondent
Counsel Full Name
Counsel Address
Counsel Address 2
Counsel City
Counsel State	choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Counsel Zip
Counsel Telephone
Counsel Fax
Counsel Email

Party 2

Party 2 Full Name
Party 2 Role	choose a role Claimant Respondent Claimant/CounterRespondent Respondent/CounterClaimant CounterRespondent
Counsel Full Name
Counsel Address
Counsel Address 2
Counsel City
Counsel State	choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Counsel Zip
Counsel Telephone
Counsel Fax
Counsel Email

If there are no additional parties, click here.

Othewise, proceed below...

Party 3

Party 3 Full Name
Party 3 Role	choose a role Claimant Respondent Claimant/CounterRespondent Respondent/CounterClaimant CounterRespondent
Counsel Full Name
Counsel Address
Counsel Address 2
Counsel City
Counsel State	choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Counsel Zip
Counsel Telephone
Counsel Fax
Counsel Email

Party 4

Party 4 Full Name
Party 4 Role	choose a role Claimant Respondent Claimant/CounterRespondent Respondent/CounterClaimant CounterRespondent
Counsel Full Name
Counsel Address
Counsel Address 2
Counsel City
Counsel State	choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Counsel Zip
Counsel Telephone
Counsel Fax
Counsel Email

Party 5

Party 5 Full Name
Party 5 Role	choose a role Claimant Respondent Claimant/CounterRespondent Respondent/CounterClaimant CounterRespondent
Counsel Full Name
Counsel Address
Counsel Address 2
Counsel City
Counsel State	choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Counsel Zip
Counsel Telephone
Counsel Fax
Counsel Email

Party 6

Party 6 Full Name
Party 6 Role	choose a role Claimant Respondent Claimant/CounterRespondent Respondent/CounterClaimant CounterRespondent
Counsel Full Name
Counsel Address
Counsel Address 2
Counsel City
Counsel State	choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Counsel Zip
Counsel Telephone
Counsel Fax
Counsel Email

Party 7

Party 7 Full Name
Party 7 Role	choose a role Claimant Respondent Claimant/CounterRespondent Respondent/CounterClaimant CounterRespondent
Counsel Full Name
Counsel Address
Counsel Address 2
Counsel City
Counsel State	choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Counsel Zip
Counsel Telephone
Counsel Fax
Counsel Email

Party 8

Party 8 Full Name
Party 8 Role	choose a role Claimant Respondent Claimant/CounterRespondent Respondent/CounterClaimant CounterRespondent
Counsel Full Name
Counsel Address
Counsel Address 2
Counsel City
Counsel State	choose a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Counsel Zip
Counsel Telephone
Counsel Fax
Counsel Email

Case Information

All fields are required.

Case Type:
Select Admiralty/Jones Act Banking Business/Commercial Civil Rights Class Action/Mass Tort Construction Contracts Corporate Dispute/Dissolution Franchise/Securities Employment/ADA/Discrimination Envrionmental/Toxic Tort FELA Insurance Policy Disputes Intellectual Property Personal Injury Personal Injury Auto Premises Liability Product Liability Professional Malpractice Property Damage Real Estate Subrogation Will/Trust/Probate Other


Have the Parties Signed an Agreement Containing an Arbitration Clause?
Yes No


Have All Parties Consented to Arbitration?
Yes No


The Costs of Arbitration are to be...
Split Equally Paid by Claimant Paid by Respondent


E-mail Address

720 Olive Street, Suite 2300, Saint Louis, Missouri

Copyright 2006 United States Arbitration & Mediation Midwest, Inc.