Please see disclaimer
     
    Please tell us a little about yourself.
     
   
Type of Business Have you used attorneys for collection previously?
Collection Agency Yes
Retail/Service Oriented Business No
Other Not Applicable
       
How did you hear of us?    
Commercial Law League Browsing Web
Other trade publication Referral From:
Business Card/Brochure  
       
Comments:
 
   
Name:    
Company: Address:
City: State/Province:
Country: Zip/Post. Code:
Phone: Email:
       
 
   

 
Your Name:   Company Name:
Debtor Name:   Assets: Yes No
Address:   Employment: Yes No
City:   Employer Name:
State:   Employer Phone:
Zip:   Employer Address:
Phone:   Asset info:
Alt. Phone:   Banking Info:
Fax:   Date of Last Sale:
Contact Name:   Amount of Debt:
         
Notes:
 
         
Attach File:
         
       
       
   
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