Stone & Saunders - Account Placement Form

1
Have you previously placed accounts with Stone & Saunders?
Please Select
Please Select
Yes
No
If "Yes" then we only require your phone# and Email address Below.
2
Your Company Name
3
I, Your Name * , certify that I am authorized to commission Stone & Saunders initiate collections on behald of .
4
Your Company Address* This field is required.Where do you want your money sent?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Phone Number* This field is required.How can we reach you if we need to talk?
Please enter a valid phone number.
6
Email Address* This field is required.If we require non-urgent information regarding the debts, who should we email?
example@example.com
7
Name of debtor 1Who owes you money?
8
Debtor Phone - debtor 1
Please enter a valid phone number.
9
Alternate Phone - debtor 1If you have more than 2 phone Numbers please enter the addtional numbers on the next page
Please enter a valid phone number.
10
What is the Current Balance? - Debtor 1* This field is required.
11
Does the current balance include late fees or interest applied?
Please Select
Please Select
Yes
No
12
Date of ServiceWhat date was the service provided or product sold?
Date
Month
Day
Year
13
Has the debtor made partial payments?Has there been any payments or credit made towards the oringal invoice(s)?
Please Select
Please Select
Yes
No
14
Last Payment Date
Date
Month
Day
Year
15
Additional Information - Debtor 1If you have addtional phone#'s, email addresses or detailed back-story on this account please provide details here.
16
Would You Like us the report to debtors credit? Please note: Backup documentation must be provided in order to report to credit bureaus. (Some examples include: Contracts, invoices, email chains reflecting service requested and/or recieved.)
Yes
No
17
Please attach any documentation that is available.The more information our team has the better. Please attach any documents you have regarding the debt. Examples: contracts, invoices, email chains ect. You may provide addtional documetions at any time by sending attachments to New@stonesaunders.com
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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