Intellectual Property Arbitration Claim Packet
Included here are the forms you need to file an Arbitration Claim with the Forum.
Instructions
1. Fill out the Submission to Arbitration Form as completely as possible.
2. If you have a pre-existing agreement to arbitrate, gather and include a copy. If
you do not have a pre-existing agreement, use the Agreement to Arbitration in
this packet.
3. Prepare your Claim and any supporting documents you want to submit initially
with your Claim (no documents other than an agreement to arbitrate are
required).
4. Prepare the payment. Our payment information below includes the mailing
address for checks as well as options for filing and paying online or faxing
payment information via credit card.
5. File your Claim.
Claims can be filed online at
http:// secure.adrforum.com/DDFiling/Default.aspx?Ruleset=CODE
Or emailed to the FORUM at info@adrforum.com
Mail to:
Forum
P.O. Box 50191
Minneapolis, MN 55405
Courier (e.g. FedEx) :
Forum
6465 Wayzata Blvd.
Suite 450
St. Louis Park, MN 55426
FORUM Submission to Intellectual Property Arbitration Form
Please complete this form and submit it to the FORUM with the appropriate filing fee.
1. Claimant/Plaintiff’s Name:
Claimant/Plaintiff’s Attorney (if one):
Please provide contact information you would like FORUM to use:
Address 1: Company or Law Firm
Address 2: Street Address, Building/Suite:
City:
State:
Telephone:
Fax:
Email:
CC Email:
Zip:
2. Respondent/Defendant’s Name:
Respondent/Defendant’s Attorney (if one):
Please provide contact information you would like FORUM to use:
Address 1: Company or Law Firm:
Address 2: Street Address, Building/Suite:
City:
State:
Telephone:
Fax:
Email:
CC Email:
Zip:
3. If a legal action pending, please forward a copy of the Scheduling Order.
4. Brief description of the dispute and relief being sought (include amount in
dispute and/or non-monetary remedies):
5. Preferred location of the Arbitration:
Location Specified in Contract
6. For Smaller Claims (under $75,000), please select:
□ Document Hearing
□ Participatory Hearing
7. Is there an agreement between the parties related to ADR services?
□ Yes
□ No
If yes, please attach a copy of the agreement.
8. Sign and date this form. By signing you request Arbitration services be provided by
the FORUM in accordance with the FORUM’S Intellectual Property CODE of Procedure.
Your Signature:
Today’s Date:
Please Print Your Name:
Your Role in this Matter:
9. Submit Form, Arbitration Clause or Agreement to Arbitrate (if available),
Scheduling Order (if one) and appropriate filing fee to: FORUM, 6465 Wayzata Blvd,
Suite 480, Minneapolis, MN 55426
10. Deliver a copy of this Request to the other parties.
11. Keep a copy for your records.
The Arbitration Team at FORUM is available to answer your questions by phone at 800-4742371 or 952-516-6400, or by fax at 866-743-4517 or 952-345-1160 or by email at
info@adrforum.com. For more information, please visit www.adrforum.com.
AGREEMENT TO ARBITRATE EXISTING INTELLECTUAL PROPERTY DISPUTE
The Parties agree to submit to binding arbitration by the FORUM, - under the Code of Procedure for
Resolving Intellectual Property Disputes the following matters in dispute:
[Please supply a brief statement of the dispute to be resolved]
Date
Date
Party Name
Party Name
Represented by
Represented
By
Signature of
Signature of
party or rep.
party or rep.
Contact
Contact
Information
Information
Name
Name
Address
Address
Telephone
Telephone
Fax
Fax
Email
Email
FORUM Payment Information
Payments can be made via check, credit card, or wire transfer and, where possible, should
be accompanied by the claim number.
Payments by check can be mailed to:
Forum
P.O. Box 50191
Minneapolis, MN 55405
Or sent via courier to :
Forum
6465 Wayzata Blvd.
Suite 450
St. Louis Park, MN 55426
If you’d like to make a wire payment, please contact your case coordinator for the
information and please advise your case coordinator of the date and amount of the transfer
so we can properly credit it.
Payments made via credit card can be made using the form below. If you prefer not to
provide your full credit card number on the form, please call the Forum after you submit the
form to have your transaction processed over the phone.
CREDIT CARD AUTHORIZATION FORM
Case number if known : FA ____
Case Name:
Party for whom the fee is being paid:
What fee is being paid: (Filing fee, deposit, etc.)
Amount:
Date:
Card Type: Visa
I authorize the payment amount stated above to be made from the credit card referenced.
Credit Card Number:
Name on Card:
Expiration Date:
I authorize the payment amount stated above to be made from the credit card referenced. I will
provide full payment details over the phone.
Last four digits of card:
Name on Card:
Expiration Date:
______________________________________
Name
______________________________________
Signature
________________________________________
Date