Placement Form

Ny debitor formular

Please complete and submit the form below and we will contact you within 48 hours with a proposal for cash purchase of your debt.

Please provide as much information as possible about the debt, this improves your chances of selling the debt to us. Please feel free to call and speak to our Debt Buying Manager if you have any questions or have multiple debts that you would like to sell.

Your company information:

Company:

Are you a client?

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Your company information:

Company:

Are you a client?

Contact:

ABN/ACN:

Address:

ZIP code:

Street address = Postal address?

Phone:

Mobile:

URL/Website:

Email:

Debtor information:

Name:

ABN/ACN:

Contact name:

Address:

ZIP Code:

City/state:

Country:

Phone:

Mobile:

URL/website:

Email:

Inv. date:

Inv. No.:

Amt. owe:

Invoice:

Quote:

Pur. order:

Contract:

Is the debt disputed?

Has there been any recent contact?

Do you have any security for payment?

Is there a Guarantor?

History:

Comments:

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