CASE TRANSMITTAL FORM
Case Name:  
Your Name:  
Your Firm:    
Telephone:   Fax:
Mailing Address:   Email:
Your Client:   Plaintiff:
Defendant:
Other Parties and Representatives:
Name:     Plaintiff:
Defendant:
Represented By:      
Telephone:   Fax:
Company/Firm:      
Mailing Address:  
         
Name:     Plaintiff:
Defendant:
Represented By:      
Telephone:   Fax:
Company/Firm:      
Mailing Address:  
         
Name:     Plaintiff:
Defendant:
Represented By:      
Telephone:   Fax:
Company/Firm:      
Mailing Address:  
     
Type of Case:  
Chosen Neutral:  
Status of Case:
Latest Demand:   $ Latest Offer: $
Litigation?:   Yes      No Key Dates:
Have all other parties agreed to mediation?   Yes      No
Explain:  
Fees & Expenses to be paid by:  50/50 Split:
Referring party:
Other:
Special Instructions/Comments: 



Wakeen & Associates Mediation Services

601 Union Street
Suite 4200
Seattle, WA 98101
Phone: (206) 292-8300
Fax: (206) 292-8399