Submit A Claim

To submit a claim, please click the email button below and a client liaison will be in touch within 24 hours to discuss your  matter or claim in specific detail.  Should you choose to engage this firm to represent you or your company in any matter, we will forward to your attention a claim authorization/retainer agreement allowing this firm to represent your interests in this matter and explaining all terms and conditions of the representation.  Before we can proceed with any claim on your behalf, we must receive the claim authorization form mentioned above and you may be required to forward to us, any additional paperwork or information necessary to effectuate your claim. The Rules Regulating The Florida Bar [4-1.5(f)(2)] require that contingent fee agreement must be signed.     

Go To Home Page

               Toll Free 1-800-367-1174

          Commercial Collections

  Tired of chasing your debtors? Call us today!

              Consumer Collections    
                           Toll Free 1-800-367-1174

 

Claim Submission Form

  Please Fill In Debtor Information Here

Debtor Name    Contact

Address 1 Address 2

City   State Zip Code  

 Select The Country You Are In

Phone Cell Phone Fax

Email Address     Web Address 

            

  Information On Receivables To Place For Collection

Total Debt To Place    Number of Accounts 

Description of Debt   

Avg Placed Monthly     Avg Age of Debt

General Location of Debtors -     City    State    

 Debtors Country

 

   Please Check All That Apply For The Receivables You Wish To Place

 Written Contract   Oral Contract    Judgment    Promissory Note    Loan 

 Short Term Note      Long Term Note      In-House Credit Plan

Ever placed with a collection provider previously? 

 

Special Requirements Of Collection Provider or Additional Comments  

  

Creditor Information
Full Name
 Title
 Company Name
Address 1
Address 2
Phone
 Fax
 E-mail

Please institute no proceedings, incur no expenses, make no compromises and/or grant extensions without written authorization.   All payments less your commissions must be remitted as received.  Collect interest wherever possible.  Claimant prefers all correspondence be conducted through our office.

This account is forwarded in accordance with the operative guides and receivers adopted by the commercial law league of America, to which we subscribe.  Failure to acknowledge claim, answer letters, or follow claimants instructions, will leave claimant free to recall this claim without payment of commissions to you.  Report promptly the possibility of collections.  If suit is advisable, state exactly what papers and cost you will require.  Charges and disbursements due on other claims must not be deducted from the amounts collected on this claim.

If these terms are not acceptable, please return immediately stating the reasons.  Please acknowledge receipt, stating whether the terms and conditions are satisfactory.

 

DISCLAIMER: The hiring of a lawyer is an important decision that should not be based solely upon advertisement. Before, you decide, please ask us to send you free written information about our qualifications and experience.

Should you choose to engage this firm to represent you or your company in any matter, we will forward to your attention a claim authorization/retainer agreement allowing this firm to represent your interests in any matter and explaining all terms and conditions of the representation. Before we can proceed with any claim on your behalf, we must receive the claim authorization form mentioned above and you may be required to forward to us, any additional paperwork or information necessary to effectuate your claim. The Rules Regulating The Florida Bar [4-1.5(f)(2)] require that contingent fee agreement must be signed.

 
 

Website Design, Optimization and Hosting By Top Ten Marketing

Copyright 2006 The Law Offices of Jeffrey J. Needle, P.A.

All rights reserved.