New Placement

NEW PLACEMENT

Brian Dixon - (303) 502-5663 EXT:142 - b.dixon@tuckeralbin.com
Your Phone Number
Format: (000) 000-0000.
Your Company Name
Your Email Address
example@example.com
Debtor Business Name
Name of Contact at Debtor Business
Total Amount Owed
Date of Last Invoice or Payment

MonthDayYear
Does your contract, statement or invoice allow for or inform the debtor that they will have to pay for collections fees when placed into collections?
Debtor Phone Number
Format: (000) 000-0000.
Debtor Address (Fill in as much as possible)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Debtor Email Address
example@example.com
Please upload Invoice, Statement and Contracts

Cancelof
Please add any other information that will help in the collection of the debt. Including other contact information, names and descriptions of debt and any disputes.
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 Brian at Tucker, Albin & Associates.

(303) 502-5663 Ext. 142

b.dixon@tuckeralbin.com.

I appreciate the opportunity and please don't hesitate to reach out with any further questions.
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