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New Client Transmittal Form

Please complete the form below to provide Real Estate Mediation Service with the information needed to begin assessing your matter. Your responses will help our team understand the dispute, identify the parties involved, and prepare for the next steps in the mediation process.

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How to Use This Form

This form is divided into five short sections. Please provide as much information as possible and review your answers before submitting. Once received, our team will review your submission and contact you regarding the next steps, including any additional information or documents that may be needed.

REAL ESTATE MEDIATION SERVICE

103 N. Meadows Drive, Suite 211, Wexford, PA 15090 412-206-5055 mediaterealestate@gmail.com www.mediaterealestate.net

REALTORS® Association of Metropolitan Pittsburgh Dispute Resolution System

__________________________________

Part 1.A : Claim Details

Brief Summary of Dispute:
Is the Other Party Aware of the Dispute?

__________________________________

Part 1.B: Claim Details - Party Filing Claim

Do you need to add any additional people to the Party Filing?
Yes
No

__________________________________

Part 1.C: Other Party (Contact Information must be Provided)

Do you need to add any additional people to the Other Party?
Yes
No

__________________________________

Part 2: Legal Counsel or Attorney

Do you have a Legal Counsel or an Attorney Involved?
Yes
No

__________________________________

Part 3: Was a Real Estate Agent / Broker or Other Professional Involved?

Was an Agent or Other Professional Involved?
Yes
No

__________________________________

Part 4: Services & Payment

Please check the appropriate amount:
Total claim is an amount less than $4,000.00.
Total claim is an amount between $4,000 and $8,999.00.
Total claim is an amount of $9,000.00 or more or is a claim for Specific Performance.

Option 1: Please pay online via our website: www.mediaterealestate.net or mail all checks to Real Estate Mediation Service, 103 N. Meadows Drive Suite 211, Wexford, PA 15090

  • $200.00 per party for claims less than $4,000.00;

  • $350.00 per party for claims between $4,000.00 to 8,999.00;

  • $500.00 per party for claims of $9,000.00 or more

Option 2:

Pay your portion of the Mediation Fee below Directly Below.

Option 2: Pay Directly Below:

Please note: - There is a 3% convenience fee for payments completed online. - All mediation fees must be received prior to the date of the mediation.

__________________________________

Part 5: Acknowledgment and Sign off

Note: Any questions or concerns please reach out to Alicia Nocera at the same email or by phone 412-206-5055.

I acknowledge the submission of the above dispute for Mediation (either draw Signature or click on Tt to type)

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Revised: 07/14/26

Most People Who Come to Real Estate Mediation Service Have Never Mediated a Dispute Before

Buyers, sellers, and property owners who found themselves in a dispute they did not plan for. Our mediators have spent decades helping people in your exact position understand their options and move forward.

 

You do not need to have it all figured out before you reach out.

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