CCAA
 
 
 
 
   
 

Required Information:

Submitted By:
Placement Date

Date Debt Incurred

Name of Company

Owner/Principal

Contact

Street Address

City

State

Zip Code

Home Phone

Business Phone

Additional Phone

If disputed, or if dispute is unique to your
industry, please explain:

Amount Due

Comments:

To increase the possibility for recovery please fax the following to us at 630.279.7045:

  • Statement of Account
  • Correspondence
  • Principal's residence info.
  • Invoices
  • NG Check
  • Debtor's bank info.
  • Trade references
  • Proof of delivery or purchase order

Free Demand
Immediate

The following account is submitted for your prompt attention. Please follow our instructions indicated above, and keep us advised of further developments. We agree to pay you your current contingent fee on any payments or accounts withdrawn pending collection.

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