Debt recovery placement form for existing clients only

Note: If you are not already a Score client then you must join first

Note: If you have another debt to place today then submit this one and repeat the process from the start

Existing Client Details

Your Company Name *

Client Code *

Your Name *

Your E-mail *

Data of Submission

Debtors Details (Details of the money owed to you)

Your Reference Number

Debtors Company / Personal Name *

Debtors Trading Name *

Debtors ABN

Debtors Street Address (or Last Known Address) *

Debtor Alternative or Postal Address

Debtor still at street address? *

Contact name at debtor business

Debtor Business Phone

Debtor Business Fax

Debtor Home Phone

Debtor Mobile

Debtor E-mail Address

Actual Amount Owing to You *

$

This amount is your actual debt before our fees are added.

Add Score Fees *
You can add our fees and a commission calculation to any debts you place provided that you have the correct documentation allowing for this

Scores Fees Amount (include commission)

$

Starting Date of Debt *

Ending Date of Debt *

Details of the debt (Insert details) *

Guarantees Held

Details of Guarantee – date and names
Is this debt disputed?
Please provide us details of the dispute

Your Instructions

Other Instructions

Has account been held by an agent or solicitor before *

56015

Debt recovery placement form for existing clients only

Existing Client Details

Debtors Details (Details of the money owed to you)

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