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Florida Office
1688 Meridian Ave
Suite 418
Miami Beach, Florida 33139
(TEL) 305-672-9544
(FAX) 305-672-4572

COLLECTION CLAIM FORM

Debtor

Name
Title
Organization
Street address
Address  (cont.)
City
State/Province
Zip/Postal  code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Creditor

Name
Title

Organization

Amount of Claim:

Bank Information:

Creditors Compositions

INDIVIDUAL
PARTNERSHIP
CORPORATION - Inc. In the State of:

Instructions to the Attorney

Submit Suit Requirements Investigate and AdviseFile Suit Immediately

Basis of Claim

Merchandis Note Service Contract

Our Experience

Broken Promises Partial Payments Stopped Payments NSF Checks
Dispute (See Remarks) Unable to Contact Pleads Poverty  

Enclosures

Statements Invoice Note(s) NSF Checks
Contract Suit Costs    

Remarks

Forwarded By:

Name
Title
Organization
Street address
Address  (cont.)
City
State/Province
Zip/Postal  code
Country
Work Phone
FAX
E-mail
URL

 
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