APPLICATION FOR ARBITRATION OF AN ACCOUNT
I, the undersigned, ___________________________________________________________________________
(client’s name)
(domicile)
declare that:
(1) _____________________________________________________________________________________ (member’s name)
is claiming from me (or refuses to reimburse to me) a sum of money for professional services.
(2) I have enclosed a copy of the conciliation report.
(3) I am applying for arbitration of the account under the Regulation respecting the conciliation and arbitration procedure for the accounts of members of the Ordre professionnel des technologues professionnels du Québec (chapter C-26, r. 263).
(4) I have received a copy of the Regulation mentioned above and have taken cognizance thereof.
(5) I agree to submit to the procedure provided for in that Regulation and, where required, to pay to ___________________________________________________________________________________________ (member’s name)
the amount of the arbitration award.
_____________________________
Signature