Submit a Claim
Submit a Claim
Once the account has been assigned we will immediately start work on it.
Submit a Claim
Existing Customer
New option_1
All Accounts Legally Litigated: 50%
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Rec.Management on Returned Checks: 38%
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Rec. Management on Medical Accounts: 32%
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Rec. Management on Commer.Accounts: 35%
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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 %]
New option_1
Account Type [Rec.Mgt.on Comm. A/c.35%]
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Account Type [Rec. Mgt. on Med. A/c.32%]
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Account Type[Rec.Mgt.on Ret.Chq.A/c.38%]
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Account owed to you
Interest Rate (default 10%)
Date of Service
Date of Last Payment
Report to Credit Bureau (YES)
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Report to Credit Bureau (NO)
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Date & Result of last Conv. with Debtor
Your Company Name
Your Name
Your Title
Phone No.
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