Claim Form
By Completing and submiting the form below, I/we the claimant(s) do hereby pass the debtor for your collection services.
Todays Date (*)
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Debtor Trading Name (*)
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Debtor Status (*)
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Debtor Contact Name
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Position
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Date of Birth if known
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Debtors's Address (*)
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Debtor Tel
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Debtor Fax
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Debtor Mobile
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Debtor Email
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Brief Invoice Description (*)
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Original Invoice Date (*)
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Invoice Amount incl VAT (*)
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Upload Invoice
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If you are unable to upload a copy of your invoice please fax to us on 08444 159201 clearly indicating your company name and client number or post a COPY to us
Invoice Sent By (*)
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Debtor Bank Branch Address
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Sort Code
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Account Number
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Is the Debtor in Liquidation or Administration (*)
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Reason for Non Payment (*)
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Clients Trading Name (*)
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Client Number
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Clients Address (Not required if you have your client number)
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