CLIENT QUESTIONNAIRE
(Items marked * are essential)

CLIENT/CLAIMANT'S DETAILS

* Company or Business Name/Status ...................
  Trading name (if different) .......................

* Address ...........................................
  ...................................................
  Tel ...............................................
  Mobile ............................................
  Fax ...............................................
  E-Mail Address ....................................
* Contact Name/Position .............................

DEBTOR'S DETAILS

  Full Name of Debtor (if Individual) ...............
* Company or Business Name (in full) ................
  Trading Name (if different) .......................
* Status (Limited Co/Partnership/Sole Trader) .......
  Directors/Proprietors/Partners (full names)
  ...................................................
* Home/Trading Address ..............................
* Registered Office (Limited Co only) ...............
  ...................................................
  Tel ...............................................
  Fax ...............................................
  Contact Name/Position .............................

FULL DETAILS OF DEBT

* Breakdown of amount(s) owing ......................
  ...................................................
* Details of goods/services supplied ................
  ...................................................
* Name of person that took the order ................
* Method of order e.g. phone/fax/letter/in person ...
* Date of order .....................................
* Date of delivery ..................................
* Invoices - date sent (with order/at a later date) .
  ...................................................
* Any other history:

* Details of credit notes raised etc ............
* Reasons for issue .............................

* Details of any assets you are aware of that are owned by the Debtor:
  ...................................................
  ...................................................
* Steps take to recover debt: .......................
  ...................................................
* Details of telephone calls/letters and relevant responses (if any)
  ...................................................
* Details of notice before proceedings/letter before action (if any)
  ...................................................
* Details of any response received ..................
  ...................................................
  ...................................................

IMPORTANT - Please ensure that you have enclosed the following documents:
1. Copy invoices 2. Copy credit notes 3. Copy letter before action