Application
90 Nine Limited
/
Day
/
Month
Year
First Name
*
Last Name
*
Email
*
Creditor (your) email
Contact Number
*
-
Area Code
Phone Number
Debtor(s) Name
*
Debtor(s) contact number/email
*
Total debt amount
*
Please note, we do not collect debts under $2000.
Is the debt disputed?
*
Yes
No
Reason for dispute
Information relating to the dispute.
Multiple debt?
*
Yes
No
Please list the debtors and individual debt amounts below
*
Invoice(s)
*
Browse Files
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Please attach the invoice(s) which stipulates the debt amount.
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of
Supporting documents
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Please attach any relevant documents (e.g. contracts, personal guarantee, court orders, activity statement, correspondence relating to debts etc).
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of
Additional information relating to the debt
Any other relevant information that will assist us in our review of your application.
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