90-Day Arbitration Agreement File a Claim 90-Day Step 1 of 2 50% ClaimantName* First Name Last Name Street Address* Street Address Line 2 City* Country* State* Zip Code* Email Address* Fax Number Phone Number*Are you; Individual Claimant Entity Claimant More than one Claimants or both Entity(s) and Individual(s) Attorney on behalf of claimant(s) Are your Represented by a Legal Counsel?* Yes No Are your Represented by a Legal Counsel? Yes No Entity must be represented by an attorney at law and the NYSAA doesn’t permit individuals none lawyers form representing the moral entity.Are you Representing Yourself in this Dispute? Yes No Already have legal counsel If you have more claimant than you can mail us at ADMIN@NYSAA.NYCBefore committing to Represent yourself individually make sure you are familiar with the NYSAA Rules and Regulations. You hereby Acknowledge having Read all Rules and Regulations of the NYSAA and feel capable and competent enough to sustain this dispute through self-representation and the risks associated with self-representation. Please Note that Entities must be represented by Counsel.Please file this form once you have identify legal counsel to represent you and provide its information.Claimant InformationName* First Last Street Address* Country* State* City* ZIP / Postal Code* Fax Phone*You will need an attorney to pursue this claim before obtaining an Index NumberAttorney Contact InformationName* First Last Street Address* Phone Number*Country* State* City* ZIP / Postal Code* Email Address* Your Website URL Claimants Represents all claimants Represents Only Me Add Claimants Yes No Add Claimant 1Name* First Last Street Address* Street Address Line 2 City* Zip Code* Email* Fax Number Representative Attorney 1Name* First Last Phone Number*Email Address* Add Claimants Yes No Add Claimant 2Name* First Last Street Address* Street Address Line 2 City* Zip Code* Email* Fax Number Representative Attorney 2Name* First Last Phone Number*Email Address* Add Claimants Yes No Add Claimant 3Name* First Last Street Address Street Address Line 2 City Zip Code* Email* Fax Number Representative Attorney 3Name* First Last Phone Number*Email Address* Add Claimants Yes No Add Claimant 4Name* First Last Street Address Street Address Line 2 City Zip Code* Email* Fax Number Representative Attorney 4Name* First Last Phone Number*Email Address* Add Claimants Yes No Add Claimant 5Name* First Last Street Address Street Address Line 2 City Zip Code* Email* Fax Number Representative Attorney 5Name* First Last Phone Number*Email Address* RespondentRespondent name First Last Respondent address Street Address Street Address Line 2 City Country State ZIP / Postal Code Phone NumberEmail Address Is Respondent Individual Entity Respondent Representative Attorney Yes No Self Represented Entities Must be Represented by Counsel to pursue the ClaimRepresentative AttorneyName First Last Phone NumberEmail Address Respondent Represents all respondent Represents Only Me Add Respondent Yes No Respondent 1Respondent 1Name First Last Address Street Address Street Address Line 2 Country State city ZIP / Postal Code Email Address Phone NumberAdd Respondent Yes No Respondent 2Name First Last Address Street Address Street Address Line 2 Country State City ZIP / Postal Code Phone NumberEmail Address Add Respondent Yes No Respondent 3Name First Last Address Street Address Street Address Line 2 Country State City ZIP / Postal Code Phone NumberEmail Address Add Respondent Yes No Respondent 4Name First Last Address Street Address Street Address Line 2 Country State City ZIP / Postal Code Phone NumberEmail Address Add Respondent Yes No Respondent 5Name First Last Address Street Address Street Address Line 2 Country State City ZIP / Postal Code Phone NumberEmail Address Nature of the dispute / Claims & Relief*Arbitration agreement - Please upload the agreement or document upon which the NYSAA is designated as the Arbitration forum for the parties in dispute:Max. file size: 32 MB.Accept terms & conditions* I am familiar with the NYSAA Rules and Agree with them all Agreed and Acknowledged {all_fields}
