HORN COLLABORATIVE SOLUTIONS
HORN COLLABORATIVE SOLUTIONS
PLEASE INDICATE YOUR PREFERRED TIMES AND DATES:
CHECK ONE: Morning (8:30 to 12:30) ____ ; Afternoon (1 to 5) ____ ; All Day ____
ENTER SEVERAL DESIRED DATES: _________________________________
__________________________________________________________________
Please complete the form below and email to my attention.
YOUR CONTACT INFORMATION
Case Caption:
V.
Appointment Contact(s):
Phone:
Email:
PLAINTIFFS INFO
Claimants:
Attorney:
Law Firm:
Your File#
Street Address:
City:
State: Zip:
Phones:
Email:
Cell Ph:
Fax No:
DEFENDANTS INFO
Claimants:
Attorney:
Law Firm:
Your File#
Street Address:
City:
State: Zip:
Phones:
Email:
Cell Ph:
Fax No:
OTHER PARTIES:
Claim Representative
Insured:
Claim/File#
Rep:
Insurance Co/Firm:
Address:
City / State / Zip:
Phone:
Fax:
PROCEDURE?
MEDIATION OR HIGH-LOW ARBITRATION
HAVE ALL PARTIES AGREED TO THIS PROCEDURE? Yes___ No___
Notes:
PLEASE INDICATE YOUR PREFERRED TIMES AND DATES:
CHECK ONE: Morning (8:30 to 12:30) ____ ; Afternoon (1 to 5) ____ ; All Day ____
ENTER SEVERAL DESIRED DATES: _________________________________
__________________________________________________________________
Please complete the form below and email to my attention.
YOUR CONTACT INFORMATION
Case Caption:
V.
Appointment Contact(s):
Phone:
Email:
PLAINTIFFS INFO
Claimants:
Attorney:
Law Firm:
Your File#
Street Address:
City:
State: Zip:
Phones:
Email:
Cell Ph:
Fax No:
DEFENDANTS INFO
Claimants:
Attorney:
Law Firm:
Your File#
Street Address:
City:
State: Zip:
Phones:
Email:
Cell Ph:
Fax No:
OTHER PARTIES:
Claim Representative
Insured:
Claim/File#
Rep:
Insurance Co/Firm:
Address:
City / State / Zip:
Phone:
Fax:
PROCEDURE?
MEDIATION OR HIGH-LOW ARBITRATION
HAVE ALL PARTIES AGREED TO THIS PROCEDURE? Yes___ No___
Notes: