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Thank you for choosing Beeline Mediations to help you resolve your dispute. Please complete the attached form to get started. We will not disclose any of your information unless you agree to it.

First Name

Last Name

Phone

Please provide a brief description of the case:

Issues in dispute:

History and status discussions (if any):

If you would like Beeline Mediations to contact your opposing party, please include their contact information below:

Relevant documents, if any

Please select the value your current dispute -ROI

Disclaimers Acknowledgement

I have read and accept the Disclaimers .