Intake Form

This Form is to be completed by parties wishing to undertake an Electronic Courthouse Resolution. Completion of this Form does not impose a binding contract.

All parties to the dispute - the Claimant(s) and the Respondent(s) - must complete an Intake Form.

On receipt of the Intake Forms from the Claimant and the Respondent, an Electronic Courthouse Case Manager will contact you.

* Denotes a mandatory field.

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Section 1: Information About This Party to the Dispute
 
1.1 * Please select one of the following that best describes the role of this party to the dispute.
  The Claimant (the party initiating a claim against another party for compensation or other redress).
  The Respondent (the party responding to the claim by a claimant, who may also be making a counter-claim in response).
 
1.2 * What is the full legal name of this party (individual, business or organization)?
 
 
1.3 * This party is:
  An individual [please skip to question 1.6]
  A business
  An organization or association
  Other [please describe]
 
1.4 The size of this party's business or organization is:
  Small (1 - 50 employees)
  Medium-sized (50 - 500 employees)
  Large (500+ employees)
 
1.5 This party's business or organization functions in the following sector:
  Retail
  Manufacturing
  Resources
  Service
  High Tech
  Other [please describe]
 
1.6 * The person representing this party in this dispute is:
  This party himself or herself
  An owner, shareholder or director of this party's business or organization
  An employee of this party's business or organization
  A lawyer
  An agent or other external representative
  Other [please describe position]
 
1.7 * This party's residence (if an individual) or the head office of this party's business or organization is located in:
  United States
  Canada
  Europe
  Other [please describe]
 
1.8 Contact information for this party to the dispute:
  Title:

First Name:

Initial:

Last Name:
 
  Organization:

Position:
 
  Address:

Suite:

City, State/Province:
,
Country:

Zip/Postal Code:
 
  Phone:

Fax:

Email:
 

Section 2: Information About The Other Party to the Dispute
 
2.1 Are there more than 2 parties to this dispute?
  No [go to question 2.2]
  Yes
  If yes, how many parties altogether:
  Claimants:
  Respondents:
Please describe the principal other party below and send a list of the name(s) and contact information for the other party(s) to casemanager@electroniccourthouse.com.
 
2.2 * Please select one of the following that best describes the other party's role in the dispute.
  The Claimant (the party initiating a claim against another party for compensation or other redress)
  The Respondent (the party responding to the claim by a claimant, who may also be making a counter-claim in response).
 
2.3 What is the full legal name of the other party (individual, business or organization)?
 
 
2.4 * The other party is:
  An individual [please skip to question 2.6]
  A business
  An organization or association
  Other [please describe]
 
2.5 The size of the other party's business or organization is:
  Small (1 - 50 employees)
  Medium-sized (50 - 500 employees)
  Large (500+ employees)
 
2.6 The other party's business or organization functions in the following sector:
  Retail
  Manufacturing
  Resources
  Service
  High Tech
  Other [please describe]
 
2.7 The person representing the other party in this dispute is:
  The party himself or herself
  An owner, shareholder or director of the other party's business or organization
  An employee of the other party's business or organization
  A lawyer
  An agent or other external representative
  Other [please describe position]
 
2.8 The other party's residence (if an individual) or the head office of the other party's business or organization is located in:
  United States
  Canada
  Europe
  Other [please describe]
 
2.9 Contact information for the other party is:
  Title:

First Name:

Initial:

Last Name:
 
  Organization:

Position:
 
  Address:

Suite:

City State/Province:
,
Country:

Zip/Postal Code:
 
  Phone:

Fax:

Email:
 

Section 3: Description of Dispute
 
3.1 * Please check up to two categories that best describe the type of dispute.
  Banking
  Bankruptcy
  Consumer Protection
  Commercial
  Contract
  Corporate
  Employment
  Family
  Finance
  Government Services
  Human Rights
  Insurance
  Labour Relations
  Landlord/Tenant
  Partnerships
  Patents/Trademarks
  Personal Injury
  Professional Services
  Real Estate
  Sale of Goods or Services
  Securities
  Taxation
  Other [please describe]
 
3.2 * Please indicate the approximate amount of the dispute in $US:
  Under $50,000 US
  $50,000 to $150,000 US
  Over $150,000 US
 
3.3 * Please describe this party's view of the complexity of the dispute.
  Straightforward
  Moderately complex
  Very complex
 

Section 4: Dispute Resolution Methodology
 
4.1 * Please indicate your one preferred dispute resolution methodology.
  Mediation-arbitration* The parties wish to adopt The Electronic Courthouse's "stepped" approach to dispute resolution, commencing with mediation and, where necessary, stepping up to binding arbitration to resolve the dispute.
  Mediation alone The parties are seeking the assistance of an expert facilitator but not a binding decision in respect of their dispute.
  Arbitration alone The parties wish to move directly to binding arbitration.
  Early neutral evaluation The parties are seeking an expert opinion on the merits of their respective positions, but not a binding determination of the dispute.
  * The Electronic Courthouse recommends our combined mediation and arbitration process as the most effective resolution process.
 
4.2 Will you require translation services to/from English? If yes, please specify languages:
  from: to:
 

Section 5: Warranties and Acknowledgements
 
5.1 * This party hereby warrants that the above information is correct to the best of her/his knowledge and belief.
  Please check to acknowledge your acceptance.
 
5.2 * This party hereby acknowledges their ability and willingness to participate in an online resolution session.
  Please check to acknowledge your acceptance.
 
5.3 Privacy/Confidentiality
  The Electronic Courthouse warrants that the information provided herein will be treated as the confidential information of its provider, for use by The Electronic Courthouse for the sole purpose of carrying out services for the applicant. Information may be anonymized (all identity information removed) and aggregated with other information for the purpose of compiling statistics on our users' needs and carrying out our commitment to continuous improvement.

 




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