INSTRUCTIONS:
1. Fill out all information requested on the form and sign in the space provided.
2. Attach a short description of the dispute.
3. Pay a non-refundable Filing Fee of $225.
4. Questions? Contact Josh at 617-895-4028 or jhoch@mwi.org.

Party Requesting Arbitration:

Consumer, Counsel, or Company – Corporate Name and DBA Name:

Full Name*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Please indicate below whether you will be represented by legal counsel at the Arbitration:*

Yes, I will be represented by Counsel
No, I will not be represented by Counsel

Other Party to the Arbitration:

Consumer, Counsel, or Company – Corporate Name and DBA Name

Full Name

Address

Street Address Address Line 2 City State ZIP Code

Email

Phone

If you have any questions, contact MWI’s Director of Mediation & Arbitration Services:

MWI
Atten: Josh Hoch
40 Court Street, 5th Floor
Boston, MA 02108
617-895-4028
jhoch@mwi.org

The undersigned understand and agree that the submission and execution of this form constitutes an agreement to submit to final binding arbitration in accordance with the motor vehicle purchase contract.

The undersigned further agree not to call any representative of Mediation Works Incorporated (MWI) or the arbitrator(s) as a witness or as an expert in any pending or subsequent litigation or arbitration involving the parties or matters relating to this dispute. The undersigned further agree that all representatives of MWI and MWI Arbitrators will be disqualified as witnesses or experts in any pending or subsequent litigation or arbitration to this dispute. The undersigned agree to defend all representatives of MWI and all MWI Arbitrators from any subpoenas from outside parties arising out of or related to this or any Appeal. The undersigned agree that no representative of MWI or MWI Arbitrator is a necessary party in any arbitration or judicial proceedings relating to this dispute. The undersigned agree that no representative of MWI or MWI Arbitrator will be liable to any party for any act or omission in connection with the arbitration of this dispute. The undersigned agree not to initiate any legal action.

By:*

Title:*

Date*
MM slash DD slash YYYY

One-page description of the dispute
Max. file size: 80 MB.

Arbitration Filing Form - Consumer Automotive

Party Requesting Arbitration:

Other Party to the Arbitration: