FORM 12.

American Arbitration Association

Commercial Arbitration Rules
Demand for Arbitration

Date: _________________

TO: (Name) _________________________________________

(of party upon whom the Demand is made)

(Address) ________________________________________

(City and State) ______________________ (Zip Code) ______

(Telephone) _______________________________________

Named claimant, a party to an arbitration agreement contained in a written

contract, dated ___________________, providing for arbitration, hereby demands
arbitration thereunder.
(attach arbitration clause or quote hereunder)

SAMPLE ARBITRATION CLAUSE: Any controversy or claim arising out of or relating to

this contract, or any breach thereof, shall be settled in accordance with the
Rules of the American Arbitration Association, and judgment upon the award may be
entered in any court having jurisdiction thereof.

NATURE OF DISPUTE:

CLAIM OR RELIEF SOUGHT: (amount, if any)

TYPE OF BUSINESS:

Claimant _________________________ Respondent ______________________

HEARING LOCALE REQUESTED: _________________________________________

(
City and State)

You are hereby notified that copies of our arbitration agreement and of
this demand are being filed with the American Arbitration Association at its
________________ Regional Office, with the request that it commence the
administration of the arbitration. Under Section 7 of the Commercial Arbitration
Rules, you may file an answering statement within seven days after notice from the
Administrator.

Signed ____________________________ Title __________________________

(May Be Signed by Attorney)

Name of Claimant ______________________________________

Home or Business Address of Claimant ______________________________________
City and State ________________________ Zip Code _______
Telephone ______________________________________

Name of Attorney ______________________________________

Attorney's Address ______________________________________
City and State ________________________ Zip Code _______
Telephone ______________________________________
--Author's Note: To institute proceedings, send three copies of this Demand with
the administrative fee, as provided in Section 48 of the Rules, to the AAA. Send
original Demand to Respondent.