Instruction to Proceed with Collection Activity

Client Information

* Client Name

* Date of Issue

* Collection Contact

* Contact Phone

* Email

Debtor Information

Personal Information:

* Surname

* Firstnames

* Address

* Phone-Home

* Phone-Work

* Mobile

Email

Date of Birth

Business Information: (If Applicable)

Business Name

ABN

Debt Information:

* Reference or Invoice Number

* Date of Debt: Between

and

* Amount of Debt

* How was Debt Incurred

Other Relevant Information

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I Agree I acknowledge that if I am not an existing Client of Paramount Collections on receipt of this instruction an Appointment of Agent and our Scale of Fees will be sent to the email address provided -which I will complete and send back to the Paramount Collections office. I acknowledge that collection activity will commence on receipt of this document. *

* Verify