Collection - Judgment Execution - Enforcement Dept.

Secure (Private) Entry Form: New Cases

Enter Accounts for:
Attachment, Collection, Execution, Foreclosure, Garnishment, LandLord, Litigation, levy, Suit, Tenant, Etc.

1.) Account Full Name:
2.) Address:
3.) Rental Address:
4.) Phone number(s):
5.) Cell:
6.) Email:
7.) Balance Owed: $
8.) Account Number:
9.) Signed Contract? Lease? Promissory Note? Installment Agreement?
10.) Date Of Charge Off:
11.) Amount Of Interest/Late Charges: $
12.) Settlement Opportunity? (Y) or (N):
13.) Payment Arrangement Opportunity? (Y) or (N):
14.) Client Contact Information:
No Collection No Fee/Court Cost Not Included

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