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Request for Collection Forms

For volume clients you may use the form as a guideline for information that is required. Email your information on a spread sheet to info@debtcollection.com.au

All accounts passed to ACS will receive a 24 hour turnaround time in addition to an up to date report.

You can then fax these forms to (02) 9790 5539 or email to info@debtcollection.com.au

Or use our Online Form below to submit debtor details.

Debtor Details

 

Date of request : 

Reference number :

Name of debtor : 


(Provide Full legal entity)
A.C.N. number : 

A.B.N. number : 

Telephone (b/h) : 
( )
Telephone (a/h) : 
( )  
Facsimile:
( )
Mobile :
Email address : 
  DOB:
Trading Address : 
Suburb : 

State : 

Postcode : 

Services / Items ordered : 

Original Amount of debt $: 

Amount paid so far $:  
Amount to collect $: 
Date of Debt :  

Cause of Action

 

Goods sold & delivered

Services rendered

Other, specify :

Work & labour done

Dishonoured cheque

     

Action Required

 

Legal action

Telephone demand

Ring client to discuss


Notes for Collector


Client Details

 

Name of firm : 


(Provide Full legal entity)
Contact name : 
Telephone : 
( )  
Facsimile :
( )
Email Address : 

 

 

 

 
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