12222 Merit Drive, 1200
Dallas, TX 75251
Phone: 214-662-3070
Mediation Services > Mediation Request Form

Mediation Request Form

To request a free consultation regarding your dispute and the potential benefits and cost of mediation, submit the form below.

Name
first last
Title
Company
Address
street line 1
street line 2
, city, state/prov zip
Email
Phone
Fax
Type of Dispute (Required)
Prefered Method of Contact
Phone
Email
  (R)
Attorney Retained?
Yes
No
  (R)
Attorney's Name
Attorney's Phone Number
Attorney's Email
Verification (to make sure you're human)

Enter the text you see in image (or refresh for new text)

Note: Please do not include any URLs in form.

You can expect a reply to your request within 24 hours.  If you need more immediate attention, call our office at 214-662-3070


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