Post Office Box 7355
Moreno Valley, California 92552-7355
(877) 45-JUSTICE
www.smallclaimshelpl.com

( Check One )
I am suing on behalf of myself.     I am suing on behalf of my business.
Plaintiff Name:
Address:
Plaintiff's City: State:                   Zip:      :
Home Phone:           Business Phone:    E-Mail: 

( Check One )

I am suing a person or people.    or    I am suing a business.
Defendant #1:               Owner (if business):  
Address:
Defendant's City:    State:               Zip:      :
Home Phone:          Business Phone:    E-Mail: 
Additional information about Defendant #1


PLEASE INCLUDE ALL ADDITIONAL DEFENDANTS ON THE SECOND PAGE OF THIS FORM
I have had more than 12 cases in Small Claims court this year.

Yes   No

I have sued for more than $2500.00 twice in the past year.

Yes   No

I want to sue for $    because on (date)   the defendant ( explain below )
I have asked the defendant(s) for this money, buty they still refuse to pay.

Yes   No

How did you hear about our Small Claims Assistnace Service? Website                     Friend      Client      Other

WE APPRECIATE YOUR BUSINESS