Submit Account

COLLECTION AGENCY FLORIDA 1-877-505-8343

Submit Account

Post an Account for FULL SERVICE COLLECTIONS

This submission form is for existing Full Service Clients, you can send us account information using this "e-submit form." If you have questions call 877-505-8343

Or Print this FORM and Fax to 888-520-7847

Client Information (your information)

Contact First Name *

Contact Last Name *

Date *

Title

Company *

Phone *

Email *

Debtor Information (person or entity owing money)

First Name *

Last Name *

or Company Name

Address *

Address 2

Zip

City

State

Home Phone

Other Phone #

Another Phone #

Cell Phone

Work Phone

Fax

Drivers License #

Date of Birth

Social Security #

Account Information

Amount Due *

Date Incurred

Last Charge Date

Date of Invoice

Last Pay Date

Invoice or Account #

Interest Rate

Mail Returned:

Yes

Check Applicable:

No Response

Disputed

NSF Check Returned

Claims Inability To Pay

Phone Disconnected

Would You Consider:
Suit & Judgment Enforcement?

Other

Comments