Attorney Direct Collections

Place A Claim

Please fill out the following information. If you are an existing client, just type in your password, and proceed to the debtor portion.

Client Information:

Date: Client Password:

Client Name: Client Address:

City:State: Zip:

Client Phone: Fax:

Client E-mail: Client File#:

Debtor Information:

Debtor Name: Debtor Address:

City: State: Zip:

Debtor Phone: Fax:

Debtor Contact: Debtor Country:

Oldest Invoice Date: Last Payment Date:

Last Payment Amount: Amount Due: $

Personal Guarantor: Guarantor Phone:

Guarantor Address:

City:State: Zip:

Documentation To Follow: Statement Invoices NSF Checks

Notes Credit Application Comments

Please Choose the service you desire:

Submitting this information to our office authorizes Attorney Direct Collections, Inc. to initiate collection proceedings on Client's behalf. Client agrees to be liable for the agreed upon contingency fee pending collection. Client authorizes Attorney Direct Collections, Inc. to receive, endorse, and deposit into Attorney Direct Collections, Inc. Trust Account, any and all checks issued in client's name. Attorney Direct Collections, Inc. will remit funds to client after deduction of it's fees.

LET US BE A "PAL" TO YOUR DEBTORS AND WE WILL GET THE RESULTS FOR YOU.