Collecting Debt and Providing Debt Solutions Since 1982
New Client Existing Client
Earl Ass Client #
Company Name:
Contact Name:
Address:
City:
State:
Country:
Telephone:
Fax:
E-Mail:
Debtor Information
Company Name:
Contact Name:
Address:
City:
State:
Country:
Telephone:
Account Number:
Debtor is a:Sole Proprietorship PartnershipCorporation
Debtor Financial Information
Outstanding Balance:
Last Charge Date:
Date of Last Payment:
I will submit the following documents
Statement of Account
Credit Application
Invoice Copies
Personal/Corporate Guaranty
Correspondence
Bad Check Copies
Other:
Comments and/or Special Instructions
Send a Final Notice to above debtor for Ten days.
I am authorizing Earl Associates, LLC to commence collection action against the above debtor. Earl Associates is also authorized to accept the debtor's payment (s) and deposit the payment (s) into their trust account on my company's behalf. I have read and accept Earl Associate's fee schedule for this debtor.
Your Name: