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1. Parties and Dispute. [Name and address of first party] and [name and address of second party] have a dispute involving [description of the nature of the dispute and any contracts that are involved].
2. Submission to Arbitration. We agree to submit this dispute to arbitration, to [name of Arbitrators], who were chosen by [method of selection]. Their written decision shall be binding on us.
[signatures of parties]
*** If Required By State Law ***
This Section for Notary:
STATE OF -------)
) ss: [date]
COUNTY OF ------)
On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
[Name of Notary Public]
My commission expires: [date]