AFFIDAVIT FOR WAIVER OF FEES
Pursuant to section 1284.3 of the California Code of Civil Procedure, consumers with a gross monthly income of less than 300% of the federal poverty guidelines, are entitled to a waiver of all fees and costs, exclusive of arbitrator fees. This law applies to all consumer arbitration agreements subject to the California Arbitration Act, and to all consumer arbitrations conducted in California. If you believe that you meet these requirements, please complete this form and submit it with your demand for arbitration.
| Name: |
| Address: |
| City: |
| State: |
| Zip Code: |
| Number of persons in household: |
| Gross monthly income: $ |
I hereby swear that the foregoing is a true and correct statement.
