Documents
Resources
Learning Center
Upload
Plans & pricing Sign in
Sign Out

Form for Referral of Claim for Collection

VIEWS: 283 PAGES: 3

This is a form that refers the right to collect a specific unpaid debt to a collection agency that will act on behalf of the original creditor when collecting the unpaid debt. This document identifies the creditor, the debtor, the amount owed, and the dates of the last charge and payments. This document is ideal for small businesses or other creditors who want to assign the rights to collect their unpaid debts to a collection agency.

More Info
									This is a form that refers the right to collect a specific unpaid debt to a collection agency
that will act on behalf of the original creditor when collecting the unpaid debt. This
document identifies the creditor, the debtor, the amount owed, and the dates of the last
charge and payments. This document is ideal for small businesses or other creditors
who want to assign the rights to collect their unpaid debts to a collection agency.
                        Form for Referral of Claim for Collection

(Name of Collection Agency)
(Address of Collection Agency)

Date: (Referral Date)

Creditor: (Name of Creditor) of (street address, city, state, zip code).

Telephone Number of Creditor: _________________________________

The account described below is referred to you for collection. Unless we advise you of
payment within (number) days, you may proceed with whatever steps are necessary for
collection of this account, subject to the restrictions set forth below.

Payments collected by you or paid directly to us after the expiration of the above-stated
period are subject to a collection commission as set forth in your commission schedule.
You are authorized to indorse in our name for deposit and collection all payments
received on this account. It is understood that you are not authorized to initiate legal
proceedings with respect to the described account. If you are unable to collect the
amount owed on the account you may return it to us for submission to our attorneys.

Description of Account

Debtor: (Name of Debtor) of (street address, city, state, zip code).
Amount owed: $________________
Date of last charge: ___________________
Date of last payment: ___________________
Currently employed or active in business? [ ] Yes                    [ ] No
Bank: (Name of Bank) with Branch located at (street address, city, state, zip code).
Debt is owed for: (Type of Services or Merchandise)
Additional comments: ___________________________________________________
                      ___________________________________________________


(Name of Creditor)



By________________________
  (Signature)
  (Printed Name and Title)

								
To top