Shariah Business Based Dispute Submission

Name

First Last

Phone

Email(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is this a business dispute?(Required)

YES

Business Name

Business Phone

Business Email

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

What is the name(s) of the person(s) or business involved in the dispute:(Required)

Please describe your complaint (dispute):(Required)

What are your damages? (Damages include things such as costs, repairs, lost time, and anything this dispute has caused you):(Required)

What have you done to try to resolve your dispute:(Required)

Do you have a written Contract concerning this Business:(Required)

YES

If yes, what is the nature of the contract (such as equipment or materials purchase/sale/lease/investment or business contracts):

Do you have a lawsuit related to this dispute and have an attorney:(Required)

YES

What are your available dates and times to meet our Imams: (please give us up to 3 options so we can schedule your initial meeting)

Date(Required)

Time

Date(Required)

Time

Date(Required)

Time

Other comments:

Waiver(Required)

I, the undersigned, agree and accept to engage in Shariah Based Dispute Resolution.

I acknowledge that I have read all the provisions in this letter and that I agree to the terms and conditions outlined here thoughtfully. I am committed to serving this assignment in good faith.

One of our team administrators will be in touch shortly to schedule your appointment should you have more questions please reach out to our office at 780 451-6694.

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