Fill and Sign the Breach of Contract Questionnaire Form

Breach of Contract Questionnaire Personal Information: Your Name: Home Address: Business name and address (if applicable): Phone Numbers: (Home) (Cell) (Work) Have you ever been involved in a lawsuit before? Yes No If yes, please describe: Breaching Party(s):1. Name: Home Address: Business name and address (if applicable): Phone Numbers: (Home) (Cell) (Work) 2. Name: Home Address: Business name and address (if applicable): Phone Numbers: (Home) (Cell) (Work) 3. Name: Home Address: Business name and address (if applicable): Phone Numbers: (Home) (Cell) (Work) Contract Information: Nature of contract: Date contract signed: Where signed: Date(s) contract to be performed: Date contract to be completed: Contract Price: $ Person/Entity obligated to make payment: Payment terms: Was anyone named as surety/co-signor/guarantor/indemnor? Yes No If yes, who?: Is there an insurance policy covering loss or damage under the contract? Yes No If yes, please
Describe: whether contract includes a requirement that payment for work be made by check or money order: if yes, provide details: whether contract includes a requirement that payment for work be made by check or money order: if yes, provide details: whether the contractor must provide a receipt to its customer (payment for services is usually made in cash): if yes, provide details: whether the contractor must provide a receipt to its customer (payment for services is usually made in cash): if yes, provide details: whether the contractor and its employees must have health insurance: if yes, provide details: whether the contractor and its employees must have health insurance: if yes, provide details: whether you have a legal duty to make a claim: if yes, provide details: whether you have a legal duty to make a claim: if yes, provide details: whether the contractor is obligated to make repair or replacement at the time of payment: if yes, provide details: whether you have a legal duty to make a claim: if yes, provide details 3. Name of the attorney: if attorney: 4. Name of the firm: if firm: 5. Type of claim: 6. Amount being claimed: 7. Amount being requested or reimbursed: 8. Type of payment requested or received: 9. Date of request: 10. Date of payment: 11. Name of the employee requesting payment: if employee: 12. Name of the employee who is to be reimbursed: if employee: 13. Amount to be reimbursed: 14. Date of amount being paid: 15. Amount paid to you: 16. Amount paid to attorney: if attorney: 17. Amount to be paid to attorney: if attorney: 18. Date of receipt: 19. Date of payment: 20. Number of hours per week to be requested: if requests are made for specific hours/days/times: if