Submit a Claim

 

Submit a Claim

Once the account has been assigned we will immediately start work on it.

 

Submit a Claim

Existing Customer

All Accounts Legally Litigated: 50%

Rec.Management on Returned Checks: 38%

Rec. Management on Medical Accounts: 32%

Rec. Management on Commer.Accounts: 35%

Date
Creditor (Legal Name)
Street Address
City
State
ZIP
Contact Person
Phone
Mobile Phone
WebSite Address
E-Mail Address
Debtor (Legal Name)
Your Reference #
Debtor's SSN
Debtor's Driver License #
Street Address
City
State
ZIP
Grantor or Contract
Phone
Mobile Phone
Debtor's Employee
Employer's Address
City, State, ZIP
Employer's Telephone
Financial Data for
Account Type [All legal accounts at 50 %]

Account Type [Rec.Mgt.on Comm. A/c.35%]

Account Type [Rec. Mgt. on Med. A/c.32%]

Account Type[Rec.Mgt.on Ret.Chq.A/c.38%]

Account owed to you
Interest Rate (default 10%)
Date of Service
Date of Last Payment
Report to Credit Bureau (YES)

Report to Credit Bureau (NO)

Date & Result of last Conv. with Debtor
Your Company Name
Your Name
Your Title
Phone No.


 
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