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Thank you for making a successful payment.

You can now complete the application form below.

About you (the User)

Please give us your details.
* = Mandatory field
Full name*
Company/Organisation name:
(if applicable)
Registered Address:*
Address Line 1 Address Line 2 City Region/State Postal code/ Zip code Country
E-mail address*
Access Code
Amazon access code
Seller ID
Date on which Amazon access code was provided
Day
Month
Year
Representation

If you want a representative to act on your behalf throughout the process of this case, please give details of that representative below.

If you nominate a representative below, all correspondence regarding this dispute will be sent to that representative.
I do not have a representative and wish to bypass this section
Full name*
Company/Organisation name:
(if applicable)
Registered Address:*
Address Line 1 Address Line 2 City Region/State Postal code/ Zip code Country
E-mail address*
*
I hereby give my authority for the above-named person/organisation to represent me.
Issues in dispute
In the space below, please explain the precise issues in dispute between the User and Amazon.
What recommendation(s) would you like the Mediator to make?

The Mediator can make one or more recommendations that Amazon take action. Any recommendation(s) made by the Mediator are non-binding.
Please specify in the box below what recommendation(s) you would like the Mediator to make.
Declaration
Please read the statements below and tick all the boxes before completing the form.
*
I apply to CEDR to appoint a Mediator to assess this dispute and reach a decision in accordance with the Scheme Rules.
*
I have the authority to commit to this Mediation.
*
I have tried to resolve this matter through Amazon's complaints process.
*
I Understand that it is my responsibility to pay GBP 245 plus VAT if the User's registered address is in the United Kingdom or EUR 269 if the User's registered address is in a European Union member state.
*
I understand that it is my responsibility to read and understand the Scheme Rules.
*
I understand that I must provide evidence in support of my case.
*
I understand that my claim may be unsuccessful if I do not provide sufficient evidence to support my case.
Please tick this box if you require the outcome decision in another language. If you have ticked the box, please specify which language.
Specify language:

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