Lodge Debt Online

Instruction to Proceed With Collection Activity

Debtor Information
PERSONAL DEBTOR INFORMATION (Contact details of the Person who owes the money) herein called “The Debtor”
Debtor’s Name*
Debtor’s Address*
Street Address City State / Province / Region ZIP / Postal Code
Debtor’s Phone Home*
Debtor’s Phone Work*
Debtor’s Mobile*
Debtor’s Email
Debtor’s Date Of Birth
DEBTOR BUSINESS INFORMATION OR COMPANY INFORMATION (Full particulars of the Business/Company who owes you money)
Debtor’s Business Name
Debtor’s ABN
DEBT INFORMATION (Information about the debt owed to you)
Your Reference or Invoice Number*
Date of Debt: (starting)*
DD slash MM slash YYYY
Date of Debt (finishing)*
DD slash MM slash YYYY
Amount of Debt*
How was Debt incurred
Other relevant information
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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.*
- I Agree
CollectSmart conditions
- Please let me know about your CollectSmart conditions
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COMPANY INFORMATION (Contact particulars for your Company)