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

 

Creditor Information
Name
Title
Organization

 

Amount of Claim

 

Bank Information
Name

 

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

 

Attorney Information
Name
Address
City, State & Zip

 

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

 

Please Add Additional Remarks

 

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

 

 

Designed & Optimized by Top Ten Marketing

Copyright © 2004 Columbia Financial International, Inc.

All Rights Reserved.