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RESPONDENT'S ANSWER

PRINT THIS FORM AND COMPLETE ALL ENTRIES. FORWARD COMPLETED ANSWER TO CLAIMANT'S ATTORNEYS AND FILE IN DUPLICATE WITH ARBITRATION SERVICES, INC. IF FILING COUNTERCLAIM RETURN WITH THE APPROPRIATE FEES TO ARBITRATION SERVICES, INC.

RESPONDENT'S NAME  _________________________________________________________

ADDRESS          ____________________________________________________________

TELEPHONE/FAX/E-MAIL_________________________________________________________

ATTORNEY FOR RESPONDENT___________________________________________________

ADDRESS ____________________________________________________________________

TELEPHONE/FAX/E-MAIL__________________________________________

CLAIMANT'S NAME ____________________________________________________________

CLAIMANT'S ADDRESS    _______________________________________________________

TELEPHONE/FAX/E-MAIL ________________________________________________________

ATTORNEY FOR CLAIMANT ______________________________________________________

ADDRESS    ______________________________________________________

TELEPHONE/FAX/E-MAIL ________________________________________________________

ANSWER TO COMPLAINT: ________________________________________________________

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COUNTERCLAIM: ________________________________________________________________

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NATURE OF COUNTERCLAIM:   _____________________________________________________

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FACTUAL ALLEGATIONS SUPPORTING COUNTERCLAIM: _______________________________

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MONETARY RELIEF SOUGHT IN COUNTERCLAIM: ______________________________________

OTHER RELIEF SOUGHT:   __________________________________________________________

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FILING FEE: ______________________________________________________________________