Are you submitting as a Dater or a Matchmaker?*

Primary Email*

First Name*

Last Name*

What is your current job title

Company Name

Are you representing a company? If yes, complete this field with your official Company Name. If you are not representing a company, then please enable the switch below labeled "I'm not representing a Company".

SMS Phone

Website

Full Address

Company Name of Opposing Party

Full name of the opposing matchmaker involved in the dispute.

Please provide a detailed description of the nature of your dispute, including any relevant facts, events, or interactions that led to the disagreement.*

Terms of Use

Signature

Terms of Use

Worldwide Referral Network - Dispute Resolution

Terms of Use

CONFIDENTIALITY
All information submitted will be kept confidential and used only to resolve this dispute.

THERE IS NO GUARANTEE OF THE OUTCOME
Submitting this form does not guarantee a specific resolution. We will review the details of your dispute and may contact you for further information.

AGREEMENT TO PARTICIPATE IN MEDIATION
By submitting this form, you agree to participate in mediation or a dispute resolution process as determined by the Worldwide Referral Network.

NON RETALIATION
Both parties involved in the dispute agree not to engage in any retaliatory actions during or after the dispute resolution process.

ACKNOWLEDGMENT OF THE CODE OF CONDUCT
Both daters and matchmakers must adhere to the Worldwide Referral Network's Code of Conduct. Violations of this code may affect the outcome of the dispute.

SUBMISSION AGREEMENT
By submitting this form, you acknowledge that all information provided is accurate to the best of your knowledge, and you agree to abide by any decisions made regarding this dispute.

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Terms of Use

Worldwide Referral Network - Dispute Resolution

Terms of Use