Request for Services

You may use our convenient online form, or you may use the PDF form to fax your request for service.

Today's date:
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Have you spoken to the other party about mediation?:

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Your Name:
Address:
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If you would like us to invite the other party to mediation, please give the following contact information for that party.
 
Their Name:
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Phone:
Phone2:
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USE THIS SECTION ONLY IF THE COURTS SENT YOU:
 
Which Court: Wailuku Lahaina
Court docket:
Date ordered:
Judge:
Return date:
Information given to Mediation Solutions, LLC is considered confidential and will not be sold to, or shared with anyone. The information will be used to contact interested parties for the sole purposes of scheduling a mediation.
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