Commercial Collections Nationwide, No Collection, No Charge

Assign An Account

New Collection Assignment for NEW Clients

Please email or fax any supporting documentation (e.g. credit application, invoices, copy of last check) related to this assignment to our office at fax # (916) 929-5125.

Debtor’s Information * = Required
*Debtor Name:	Required
Debtor DBA:
Debtor Entity:
*Debtor Address:	Required
*Debtor City:	Required
*Debtor State:	Required
Debtor Zip:
*Debtor Phone:	Required
Debtor Fax:
*Balance Due:	Required
*Date Last Charge:	Required
Date Last Payment:
*Debt for Goods/Services/Monies Due:	Required
Additional Comments:
Client Information
*Company Name:	Required
*Contact Name:	Required
*Contact Title:	Required
*Company Address:	Required
*Company City:	Required
*Company State:	Required
*Company Zip:	Required
*Company Phone:	Required
Company Fax:
*Company E-Mail:	Required

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