VF-3403. Horizontal Restraints--Dual Distributor Restraints Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 We answer the questions submitted to us as follows: 1. Did [name of defendant] sell [products] directly in competition with [name of plaintiff] to a significant portion of [name of plaintiff]'s customers or potential customers? ____ Yes ____ No If your answer to question 1 is yes, then answer question 2. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 2. Did [name of defendant] [stop doing business with/refuse to deal with/restrain] [name of plaintiff]? ____ Yes ____ No If your answer to question 2 is yes, then answer question 3. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 3. Was [name of plaintiff]'s refusal to agree to [name of defendant]'s [specify the claimed restraint, e.g., territorial or customer restrictions] a motivating reason for the decision to [end business with/refuse to deal with/restrain] [name of plaintiff]? ____ Yes ____ No If your answer to question 3 is yes, then answer question 4. If you answered no, stop here, answer no further questions, and have the VF-3403. Horizontal Restraints--Dual Distributor Restraints Instruction No 1 Request by Plaintiff Given as Proposed Refused Withdrawn Request by Defendant Given as Modified Requested by Given on Court's Motion Judge Instruction No 1 presiding juror sign and date this form. 4. Was [name of defendant]'s conduct a substantial factor in causing harm to [name of plaintiff]? ____ Yes ____ No If your answer to question 4 is yes, then answer question 5. If you answered no, stop here, answer no further questions, and have the presiding juror sign and date this form. 5. What are [name of plaintiff]'s damages? Presiding Juror $ Signed: ___________________________ Dated: ___________________ After [this verdict form has/all verdict forms have] been signed, notify the [clerk/bailiff/court attendant] that you are ready to present your verdict in the courtroom. _____________________________________________________________________________ New September 2003; Revised December 2010, December 2016