Collection Account Details:
You are a client of ICON and Collection Agreement has been approved by ICON, prior to submitting this account.
Who are we collecting from:
Collecting from Business
Collecting from Person
Name of Debtor
Name of Business (Only if we are collecting from the business)
Street Address Line 2
If no Phone Number, please enter last known number
Date of Birth
DOB if you have otherwise leave blank
Social Insurance Number
Sin# if you have otherwise leave blank
Last Payment Date (leave blank if none)
Drag and drop files here
Choose a file
Any Dispute on File?
We authorize ICON to start collecting as of today, and if our debtor reaches out to us after this file is submitted to ICON, we will redirect them back to ICON and also report any payments received right away.
Client Company Name
Use same name as per your Collection Agreement
Please enter a valid phone number.
Should be Empty: