Post an Account for FULL SERVICE COLLECTIONS ONLY  (Not for Do-It-Yourself)

This submission form is for existing Full Service Clients, you can send us account information using this "e-submit form."  If you have questions call 866-505-8343

Or DOWNLOAD and Print this FORM and Fax to 888-520-7847

     
   Client Information (your information)
Contact First Name *  
Contact Last Name *  
Date *  
Title  
Company *  
Phone *  
Email *  
     
  Debtor Information (person or entity owing money)
First Name *  
Last Name *  
or Company Name  
Address *  
Address 2  
Zip  
City  
State  
Home Phone  
Other Phone #  
Another Phone #  
Cell Phone  
Work Phone  
Fax  
Drivers License #  
Date of Birth  
Social Security #  
Email  
     
  Account Information
Amount Due *  
Date Incurred  
Last Charge Date  
Date of Invoice  
Last Pay Date  
Invoice or Account #  
Interest Rate  
Mail Returned:  
Yes
   
No
Check Applicable:  
No Response
   
Disputed
   
NSF Check Returned
   
Claims Inability To Pay
   
Phone Disconnected
   
Would You Consider:
Suit & Judgment Enforcement?
Other  
Comments  
   
     
     
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