Benezra & Culver, P.C.>Set an Initial Appointment for Mediation

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:


    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: