Fee Waiver Form

Arbitration Fee Waiver Form

Please enter your information to see if you are eligible for a fee waiver.
FV Email
example@example.com
zruid
First Name*
Last Name*
Email*
Street Address*
Street Address 2
City*
State*
Zip Code*
Number of people that live in your house:*

12345678
Lastly, we need your MONTHLY income. For example, if you make $36,000 a year, you would make $3,000 a month. If you make $1,500 per bi weekly paycheck, you make $3,000 a month.
Gross MONTHLY Income:*
Gross Monthly Income is total income before tax

Please make sure your information is correct
Declaration in Support of Application for Waiver of Fees – California Consumers

In consumer arbitrations in California, consumers with a gross monthly income of less than 300% of the federal poverty guidelines are entitled to a waiver of the arbitration fees. In those cases, the respondent must pay 100% of the fees.
Your Name:*
Your Address:*
Total MONTHLY income:*
Number of Persons in Household:*
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on {date}, at {city}, {state}.
Signature of Consumer*

Clear
Date

YearMonthDay
Date

Please click on the submit button to submit your form. After completion of this form there is no need to take further action. We will continue to investigate your claim and reach out with further updates.
Should be Empty:

Arbitration Fee Waiver Form