Request For Arbitration
Place and date REQUEST FOR ARBITRATION To: HTA Commercial Arbitration Center Disputing Parties[1] Claimant: ……………….…..…………………. Legal Representative: Mr. / Mrs. ………………………………. Address: …………………………………………………………… Telephone: …………………… Fax: …………………………. Authorized representative (if any): Mr. / Mrs. ………………- followed the power of attorney (or Authorization contract) dated …….. Respondent: ………………………………………………….. Legal Representative: Mr. / Mrs. ……………………………………