YOUR INFORMATION: (YOU ARE THE PLAINTIFF):

Your full name 

Your business name (legal entity):

I am/We are: -----CHOOSE ONE----- Individual/DBA Partnership Corporation LLC

The 'company' has complied with the Fictitious Business Name Filing requirements of this county under statement number: ,

which will EXPIRE on:

Your street address:  City:   State:   Zip: 

Your home phone:

Your work phone:

Your mobile phone:

Your Email address (confidential):

 IF YOU ARE FILING A Defendant’s Claim, please fill in these (3) three boxes:

Court:

Case #:

Trial date:

THIS IS CALLED “VENUE”

YOUR FACTS DETERMINE THE CORRECT LOCATION OF THE COURT FOR THE TRIAL.

OTHER PARTY'S (DEFENDANT) INFORMATION

From the top down, please select the FIRST line that corresponds

to the circumstances of YOUR situation.

----------CHOOSE ONE---------- Defendant's residence is here Defendant is a business and it's principal place of operation is here Defendant contracted here Defendant lived here when contract was formed Obligation was to be performed here The defendant corporation breached it's contract here You were injured here Your personal property was damaged here

What is the LEGAL form of Defendant’s business: Unknown Individual/DBA Partnership Corporation LLC

If you selected UNKNOWN, click HERE to fill out our "ASSIGNMENT to DETERMINE Legal Entity" form.

Full name or exact legal business entity name:

If Defendant is a CORPoration or LLC, what is the name, address and telephone number of their Agent for Service:

Full name of INDIVIDUAL Defendant:

Gender: Choose One Does Not Apply Male Female

Height:

Weight:

Eyes:

Hair (head):

Hair (face):

Age:

Race:

Street address:

City:   State:  Zip:  

Home phone:

Business phone:

Other phone:

Automobile Info:

How much will you sue for?   $

Date debt became due:

Briefly, describe the reason you are suing or the nature of your claim in the space below:

(example: Breach of Written or ORAL contract)

Address where the agreement was entered into or services were to be performed, OR, where the incident happened:

Information about any second party; if a vehicle accident, such as Owner or Driver  or the Spouse or Child or Parent; the Property Manager or Landlord, or Owner of Real Property:

If there is any other information or address that we may need to

help us make the service, please indicate below.

By clicking SUBMIT your information will be delivered to us electronically and you will be taken to a confirmation page so you can print out what you sent us.