Koschitzki v. Apple Inc. et al

Filing 23

AFFIDAVIT/DECLARATION in Support re 16 MOTION to Compel Arbitration and Dismiss Claims of Theodore Weiman filed by AT&T Inc.. (Attachments: # 1 Exhibit 1, # 2 Exhibit 2, # 3 Exhibit 3) (Greenblatt, Steven)

AMERICAN ARBITRATION ASSOCIATION SUPPLEMENTARY PROCEDURES FOR CONSUMER-RELATED DISPUTES
How to file a claim; consumers should:
· Fill out this form and retain one copy for your records. · Mail two copies of this form and your check or money order made payable to the AAA, to the AAA Case Management Center nearest to you. Please consult Section C-8 of the Supplementary Procedures for ConsumerRelated Disputes for the appropriate fee. · Send a copy of this form to the business.

How to file a claim; businesses should:
· Fill out this form and retain one copy for your records. · Mail two copies of this form and your check or money order made payable to the AAA, to the AAA Case Management Center nearest to you. Please consult Section C-8 of the Supplementary Procedures for ConsumerRelated Disputes for the appropriate fee. · Send a copy of this form to the consumer by registered mail return receipt requested.

1

How is this claim being filed? Check only one. [ ] By request of the consumer (A copy of the arbitration agreement must be attached. A copy of this form must also be sent to the business) [ ] By request of the business (A copy of the arbitration agreement must be attached. A copy of this form must also be sent to the consumer by registered mail return receipt requested) -or[ ] By mutual agreement ("submission") of the parties (both parties must sign this form)

2 3 4 5 6

Briefly explain the dispute. Do you believe there is any money owed to you? If yes, how much? Is there any other outcome you want? If yes, what is it? [ ] Yes [ ] No

Preferred hearing locale (if an in-person hearing is held) ______________________________________________ Fill in the following information Business Name of Business ___________________________ Address ___________________________________ City/State/Zip_______________________________ Telephone _________________________________ Fax _______________________________________ Signature of Business ________________________ Representative _____________________________ Firm _____________________________________ Address ___________________________________ City/State/Zip_______________________________ Telephone _________________________________ Fax _______________________________________

Consumer Name of Consumer ______________________________ Address _______________________________________ City/State/Zip___________________________________ Telephone _____________________________________ Fax ___________________________________________ Signature of Consumer ___________________________ Representative __________________________________ Firm __________________________________________ Address _______________________________________ City/State/Zip___________________________________ Telephone _____________________________________ Fax ___________________________________________

AAA Customer Service 1-800-778-7879 AAA Web site: www.adr.org