Debt Load If you are human, leave this field blank.Existing Client *YesNoYOUR DETAILS - CLIENT INFORMATIONCreditor's full legal name(s) OR Company name *Client NumberContact PersonEmail Address *Work PhoneCell PhonePhysical Address *Postal Address *Bank account number for payments *DEBTORS DETAILS The debtor is a *IndividualSole TraderPartnershipCorporationLimited PartnershipLimited Liability Company (LLC)Nonprofit Organization(Please select your debtors business type)Do you have a guarantor?YesNoDebtor's full legal name(s) OR Company name *Guarantor DetailsDate of BirthEmail AddressHome PhoneWork PhoneCell PhonePostal AddressDescription of Debt(notes and relevant information relating to the debt)Date of original InvoiceOriginal Amount OwingAmount PaidAmount Outstanding *Client Account or ReferenceAttachments(statements, invoices, correspondence etc)ACCOUNT DETAILSDo you have a collection cost clause? *YesNoUnsureIs this account disputed? YesNoI have read and understood Resolve Collections limited Terms of EngagementYesNoSubmitEmailEmail
