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1. A dispute arising out of the real estate business as defined by Article 17 of the Code of Ethics exists between me (or my firm) and (list all persons and/or firms you wish to name as respondents to this arbitration):

RESPONDENT(S):

2. There is due, unpaid and owing to me (or I retain) from the above-named persons the following sum:

3. My claim is predicated upon the facts set forth in the attached statement.
   
   Please type a detailed narrative explaining the facts in chronological order which support your claim.  Upload your typed narrative using the button below

4. Evidence
   
   Please submit all the documentary and physical evidence you have to support your case by uploading it using the button below.. Please note all evidence must be submitted as one file

5. I request arbitration through the Board and I agree to abide by the arbitration award and to comply with it promptly. In the event I do not comply with the arbitration award and it is necessary for any party to this arbitration to obtain judicial confirmation and enforcement of the arbitration award against me, I agree to pay the party obtaining such confirmation the costs and reasonable attorney's fees incurred in obtaining such confirmation.

6. I declare that this application and the allegations contained herein are true and correct to the best of my knowledge and belief and this request for arbitration is filed within one hundred eighty (180) days after the closing of the transaction, if any, or within one hundred eighty (180) days after the facts constituting the arbitrable matter could have been known in the exercise of reasonable diligence, whichever is later.

    

10. Please send a check in the amount of $350 made payable to LIBOR for the arbitration fee to the attention of the PSC Department, Long Island Board of Realtors, 300 Sunrise Hwy., West Babylon, NY 11704. Your complaint cannot be processed until this fee is received by LIBOR.