Request for conciliation

Identification
Name*
Name of the person representing (if necessary)
Address*
Address* Address line 2 City* State / Province* ZIP code* Country*
Phone number (home)*
Phone number (work)*
Email address*
Claim
Name of the claiming architect*
Amount claimed*
Beginning of rendered professional services*
Date Format: MM slash DD slash YYYY
End of rendered professional services*
Date Format: MM slash DD slash YYYY
Refusal to pay the account
Reason(s)
However (when applicable), I admit that I owe the following amount for the professional services mentioned in this account
Request for conciliation*
- I request conciliation in accordance with division 1 of the Regulation respecting the conciliation and arbitration procedure for the accounts of the members of the Ordre des architectes du Québec, a copy of which I declared that I have received and read.
- I make this solemn declaration, conscientiously believing it to be true and with the knowledge that it has the same force and effects as if it had been made under oath, in accordance with the Evidence Act of Canada.
Copy of the account

Identification