Online Debt Collection Claim Form
Claim Placement Form
Click here for a downloadable claim placement form (.pdf), or place a claim using the online form, below.
Includes automatic Ten Day Free Demand Letter. If legal action is required, claims qualifying for less than Regular Rates are forwarded as follows: 25% 1st $2,000.00, 20% excess. Minimum claim: $500.00.
PLEASE PROVIDE ALL PERTINENT DOCUMENTATION INCLUDING STATEMENT OR AGING, INVOICES (IF NOT VOLUMINOUS), CONTRACT, GUARANTY(S), CREDIT APPLICATION, AND CHECK COPIES, AS AVAILABLE.
If you are unable to fill in a field, please enter “n/a” into the field instead of leaving it blank.