TO PLACE AN ACCOUNT FOR COLLECTIONS ONLINE

TO PLACE AN ACCOUNT FOR COLLECTIONS ONLINE

Monique Alexander - (469) 424-3033 Ext.592 - m.alexander@tuckeralbin.com
Your Name*

First Name Last Name
Company Represented*
Name of Company
Phone Number*

Area Code Phone Number
Debtor Company Name*
Name of Company
Debtor Address

Street Address

Street Address Line 2

City State

Zip Code Country
Debtor Contact Name and Title*

First Last Name Title/Department
Debtor Phone Number*

Area Code Phone Number
Debtor Email Address
example@example.com
Additional Debtor Contact Information
Additional Information: (Additional contact names, phone numbers, job site location, shipper info, additional email addresses, etc.)
Date of Last Invoice or Payment*

MonthDay Year
Date
Principal Amount Due*
Exact Amount Due
Late Fees / Finance Charges Accrued*
Amount, if any
Total Amount Due*
Total Amount Due (Principal Amount + Fees)
Rate Per Collections Agreement
Percentage (if known)
Please upload any documentation you have ie; invoices, statements, contracts etc.

Browse Files
Documents supporting amount owed Cancelof
Submitting this form will place the above debtor into collections with Tucker, Albin & Associates.
Immediate contact will be made with this debtor. If they attempt to contact you in any way please refer them back to Tucker Albin & Associates.

Monique Alexander
(469) 424-3033 Ext. 592
m.alexander@tuckeralbin.com

I appreciate the opportunity and please do not hesitate to reach out with any further questions!
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