NCS - Claim Placement Form

-To print and mail / fax your form to us (together with additional documents) Click Here- NCS IMMEDIATE CLAIM PLACEMENT
COMPLETE THIS FORM BY FILLING IN ALL THE SPACES BELOW. THEN CLICK THE SUBMIT BUTTON TO SEND THE INFORMATION TO US. IF YOU MADE A MISTAKE AND WISH TO START OVER CLICK THE RESET BUTTON. PLEASE EMAIL US IF YOU HAVE ANY PROBLEMS. PLEASE PROCEED WITH IMMEDIATE COLLECTION ON THE ACCOUNT LISTED. WE AGREE TO NOTIFY YOU PROMPTLY OF ANY PAYMENTS RECEIVED. WE AGREE TO PAY YOUR FEES ON ANY PAYMENTS MADE FROM THE DATE OF ASSIGNMENT FORWARD. WE UNDERSTAND AGENCY RETAINS INTEREST COLLECTED UNLESS OTHER ARRANGEMENTS ARE MADE.
DEBTOR
ADDRESS
CITYi STATE/ZIP
NAME OF CONTACT
TELEPHONEi FAX CUSTOMER NO.
BALANCE DUEi DATE OF LAST CHARGE
DEBTOR ENTITY: CORPORATION PARTNERSHIP INDIVIDUAL GUARANTY
WE ENCLOSE THE FOLLOWING:
INVOICES ITEMIZED STATEMENT CREDIT APPLICATION OTHER DOCUMENTS
COMMENTS/SUGGESTIONS:

WE APPRECIATE ANY COMMENTS YOU FEEL WOULD BE OF VALUE IN EXPEDITING THE RECOVERY Of THIS ACCOUNT. YOU ARE AUTHORIZED TO FORWARD THIS CLAIM TO AN ATTORNEY IF NECESSARY. NO LEGAL ACTION WILL BE TAKEN WITHOUT YOUR PRIOR APPROVAL.
CREDITORi DATE
ADDRESS TELEPHONE
NAME TITLE FAX

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