Scheduling Form

MARK SHELTON PROFESSIONAL ASSOCIATION

attorney -

mediator -

arbitrator -

umpire -

(at·tor΄ney)

(mē΄dē∙āt΄or)

(ar΄ba∙trāt΄or)

(ŭm΄pīre)

Scheduling Form

Once all parties have agreed to a particular date/time, just complete this form and click to send it to us or call us at (813) 949-3681 x12.

Please Note: A mediation, arbitration or appraisal is not officially scheduled on Mark Shelton’s calendar until we have contacted you to confirm. We will make every effort to do so within a few business hours of receipt of your submission or telephone call.

Date/Time Enter the available date all parties have agree to use: -- mm/dd/yy

Choose the available time-slot option all parties have agreed to use? a.m. p.m.

Enter the preferred start time: -- hh:mm

Who Are You?

Your Name
Your Title
Organization or Firm
Postal Address #1
Postal Address #2
City
State
Zip Code
Work Phone/Ext.
FAX
E-mail
Web Address

Conflict Resolution Information Choose one of the following options:

Please provide the full case style?

Please provide the case # and Division, Court and county, if any.

This next section is to provide information about all parties to this matter. There is space provided for 2 plaintiff parties and 2 defendant parties and an area to provide information if there are more parties involved.

Party Information

For the Plaintiff Party #1, please provide the following information:

Attorney or Representative

Title

Their Assistant's Name

Organization or Firm

Postal Address #1

Postal Address #2

City

State

Zip Code

Work Phone

FAX

E-mail

Web Address

Their Client's Name

For the Plaintiff Party #2, please provide the following information:

Attorney or Representative
Title
Their Assistant's Name
Organization or Firm
Postal Address #1
Postal Address #2
City
State
Zip Code
Work Phone
FAX
E-mail
Web Address
Their Client's Name

For the Defendant Party #1, please provide the following information:

Attorney or Representative
Title
Their Assistant's Name
Organization or Firm
Postal Address #1
Postal Address #2
City
State
Zip Code
Work Phone
FAX
E-mail
Web Address
Their Client's Name

For the Defendant Party #2, please provide the following information:

Attorney or Representative
Title
Their Assistant's Name
Organization or Firm
Postal Address #1
Postal Address #2
City
State
Zip Code
Work Phone
FAX
E-mail
Web Address
Their Client's Name

Are there any other parties involved?

Yes No

If so, please provide all their contact information as you did above?

Where will it be held? Please provide the name and physical address where the conflict resolution meeting will be held.

Just click here to submit to us and we will contact you to confirm. If you should have any questions, please call us at (813) 949-3681 x12 or email at Katie@MarkSheltonPA.com.

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Contact Information: Mark Shelton, P.A.1519 Dale Mabry Highway, Suite 100, Lutz, FL 33548-3033. (813) 949-3681 or Toll Free (866) 912-4193 or Facsimile (813) 949-6216. Send e-mail to Kathleen@MarkSheltonPA.com with questions or comments about this web site. Or call (813) 949-3681 or Toll Free (866) 912-4193.
Last modified: 07/27/07