Distributor Agreement Termination Legal Consultation Intake Form
Use this intake form to share the key details, timeline, and documents related to your distributor agreement termination matter so the consultation can be prepared.
Matter and Business Information
Client/Company Legal Name
*
Distributor Name
*
Type of Distributor Agreement
*
Please Select
Exclusive Distribution
Non-Exclusive Distribution
Master Distribution
Authorized Distributor
Reseller Agreement
Sales Representative Agreement
Other
Agreement Start Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Governing Jurisdiction
*
Termination and Contract Details
Intended Termination Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Termination Reason
*
Please Select
Performance issues
Breach of agreement
Business restructuring
Mutual agreement
Other
Has Written Termination Notice Been Sent?
*
Yes
No
Date Written Notice Was Sent
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Status of Termination/Dispute Process
*
Please Select
Pre-notice
Notice sent
Dispute ongoing
Post-termination
Negotiation in progress
Other
Documents and Consultation Needs
Relevant Documents
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Summary of Issue and Desired Outcome
*
Best Contact Email and Phone Number
Submit Intake
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