Debtor
Name
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Creditor
Name
Title
Organization

Amount of Claim
Bank Information
Name

Creditors Compositions:
 INDIVIDUAL
PARTNERSHIP
CORPORATION - Inc. In the State of:

Instructions to the Attorney:
Submit Suit Requirements  Investigate and Advise   
File Suit Immediately    

Basis of Claim
Merchandise  Note         Service      Contract   

Our Experience
Broken Promises     Partial Payments
Stopped Payments     NSF Checks
Dispute (See Remarks)  Unable to Contact
Pleads Poverty

Enclosures
Statements  Invoice  Note(s)  NSF Checks
Contract  Suit Costs

Remarks
Forwarded By:
Name
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
FAX
E-mail
URL                                  

PLEASE INSTITUTE NO  PROCEEDINGS; INCUR NO EXPENSES; MAKE NO COMPROMISES; GRANT EXTENSIONS; WITHOUT WRITTEN AUTHORIZATION.   ALL PAYMENTS LESS YOUR COMMISSIONS MUST BE REMITTED AS RECEIVED.  COLLECT INTEREST WHEREVER POSSIBLE. CLAIMANT PREFERS ALL CORRESPONDENCE BE CONDUCTED THROUGH OUR OFFICE. THIS ACCOUNT IS FORWARDED IN ACCORDANCE WITH THE OPERATIVE GUIDES AND RECEIVERS ADOPTED BY THE COMMERCIAL LAW LEAGUE OF AMERICA, TO WHICH WE SUBSCRIBE. FAILURE TO ACKNOWLEDGE CLAIM, ANSWER LETTERS OR FOLLOW CLAIMANT'S INSTRUCTIONS, WILL LEAVE CLAIMANT FREE TO RECALL THIS CLAIM WITHOUT PAYMENT OF COMMISSIONS TO YOU. REPORT PROMPTLY THE POSSIBILITY OF COLLECTIONS. IF SUIT IS ADVISABLE, STATE EXACTLY WHAT PAPERS AND COST YOU WILL REQUIRE. CHARGES AND DISBURSEMENTS DUE ON OTHER CLAIMS MUST NOT BE DEDUCTED FROM THE AMOUNTS COLLECTED ON THIS CLAIM.  IF THESE TERMS ARE NOT ACCEPTABLE, PLEASE RETURN IMMEDIATELY STATING THE REASONS. PLEASE ACKNOWLEDGE RECEIPT, STATING WHETHER THE TERMS AND CONDITIONS ARE  SATISFACTORY.