Set an Initial Appointment for Mediation

Use the form below to set up an initial appointment to discuss your mediation needs with Benezra & Culver.

Mr. Benezra charges $250/hour to conduct mediations and for preparation time. The parties will be asked to complete a mediation agreement which will be forwarded to counsel in the event a mediation is scheduled.

PLEASE NOTE:Your responses are protected by attorney/client privilege and will be held in strict confidence.

We look forward to working with you!

Section 1: Contact Information

First Name (required)

Last Name (required)

Address (required)

Address 2

City (required)

State (required)

Zip/Postal Code (required)

Contact Phone (Cell or Home) (required)

Your Email (required)

Section 2: Names of parties and their counsel

Name of all potential parties and their counsels (if applicable):*

Section 3: Type of Dispute

Briefly describe the type of dispute:*

Section 4: Case Number and Venue (if the case has been filed)

Case Number:

Venue:

Section 5: Proposed Dates of Mediation and or Deadline by Which Mediation Should be Held

If you are aware of any upcoming deadlines regarding possible dates of mediation, please identify those deadlines:

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