Name of person: Name of company: Postal address: Telephone: Fax: Email: What is their role: Small Business Operator Agent Solicitor Other (specify) If interpreter is required, which language: Respondent’s Details (the other company / person / agency) Respondent Name of company / person / agency Include ABN / ACN if applicable Does respondent have an agent? Name of the agent representing the respondent (company and person) Yes No Does respondent have a solicitor? Name of the solicitor representing the respondent (firm and person) Yes No Please provide full contact details for the other side Who is the best person to contact to discuss this application on behalf of the respondent side)? Name of person:
Name of person: Name of company: Postal address: Telephone: Fax: Email: What is their role: Small Business Operator Agent Solicitor Other (specify) If interpreter is required, which language: Respondent’s Details (the other company / person / agency) Respondent Name of company / person / agency Include ABN / ACN if applicable Does respondent have an agent? Name of the agent representing the respondent (company and person) Yes No Does respondent have a solicitor? Name of the solicitor representing the respondent (firm and person) Yes No Please provide full contact details for the other side Who is the best person to contact to discuss this application on behalf of the respondent side)? Name of person:
Application-for-mediation-of-a-small-business-dispute.docx