Send Notice - Wine Code

1Claimant

2Respondent

3Notice of Dispute

4Review and Sign

Already sent a Notice of Dispute and 21-days have passed? Click here to request a mediator.
Please fill in your details below
Your Name*
Your Mobile Number*
Your Email Address*
Enter Email Confirm Email
Franchise System Name*

Please enter the respondent details below
Their Contact's name*
Contact's position*
Contact's Email*
Enter Email Confirm Email
Their Mobile Number*

Fill in details about the dispute below
(a) Nature of Dispute*
(describe what the dispute is about)
(b) Desired Outcome*
(outline what you wish to achieve)
(c) Action required to settle the dispute*
(what you want the other side to do)

Review and Sign
Name*
First Last
Signature*
Date*
DD slash MM slash YYYY
*
- I accept the Terms and Conditions and Privacy Policy