Collector's Information:
Assignment Date
Collection Co. / Tel.
Collector's Name
*
Collector's Email
*
File Number
*
Debtor Information:
Debtor Name
*
Type of Business
Contact Person / Name & Tel. No.
Street Address
*
City, State & Zip
*
Company Owed
Amount Owed
Additional Info.
Please observe:
Names of Owners, Managers, Officers
Product/Inventory, Brands/Manufacturer Information
Business or Occupational License, ICC License, Liquor License
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