Creditor Information
Creditor (You or Your Company)
Contact Name
(If Different From Above)
E-Mail
Address
City, State Zip
Phone:
Debtor Information
Debtor Full Name
Contact Name
(If Different From Above)
Address
City, State Zip
Phone
Social Security #
Driver's License #
(Please include State, Province, and/or Country)
Amount Due $
Age of Debt
Do You Have Any of the Following:
Contract?
Personal Guarantee?
Signed Document?
Judgment? (and when granted)
Check or Bank Account # of Debtor?
Credit Card # of Debtor? (please specify which card: MasterCard, Visa, AMEX, Discover, etc. ...)
Other? (please specify: invoice, etc. ...)
Has This Case Been Handled by a Lawyer?
Yes No
Has This Case Been Handled by a Collection Agency?
Yes No
Please provide brief details about this case
IMPORTANT: To help us do a thorough evaluation of the value of your judgment, please fax a copy of your judgment to 954-301-2215.
Note: judgments are public records that are available to anyone. We will not contact the debtor or proceed in the processing of your judgment without a written agreement with you.
When you have completed this information, please press the "Submit" button, and we will evaluate this case and contact you directly. You only need to press the button once.
