MediatorConsultant
Mediators Service Charge is made on:_____/_____/______/
between the following participants, who agree to pay the following fee to the Mediator Consultant
$250.00 per hour. Each participant shall pay to the Mediator and equal amount of the hourly service charge depending upon the number of participants. The Mediator is responsible for payment to the Co-mediator in the event one is required.
The participants listed below agree to pay the Mediators Service Charge of $250.00 per hour.
Client(s) Name:________________________________________________________________________
Client(s) Signature:_____________________________________________________________________
Client(s) Name:________________________________________________________________________
Client(s) Signature:_____________________________________________________________________
Client(s) Name:________________________________________________________________________
Client(s) Signature:_____________________________________________________________________
Co-Mediator(s) Name:__________________________________________________________________
Co-Mediator(s) Signature:_______________________________________________________________
Mediatorconsultant:
Charlie Williams MediatorConsultant
8345 Glenoaks Boulevard, Unit 6
Sun Valley, California 91352-3511
Phone number: 213-8194097 or 818-9513663
Fax number: 818-951-3663
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