Commercial Claim Placement Form
___________________________________________________________________________________

Information in Red is Required
Name of Your Firm
Address
City
State
Zip
Phone    Extn
Submitters Name
Fax Number
Email Address
   
________________________________________________________________________________

Debtor Information
Your Account #
Name of Debtor
 d/b/a
Principle Contact
Address
City
State
Zip
Phone    Extn
Fax Number
   
Type of Business Corporation  Partnership   Sole Proprietorship
Guarantor
 
Claim Amount
   
Type of Placement    Immediate Placement   Final Demand                                 
________________________________________________________________________________
Comments and/or Special Instructions

 

             

By submitting this claim, we acknowledge that we have read and agree with the terms specified Below.            

 

TERMS BETWEEN CREDITOR & ATWELL, CURTIS & BROOKS, LTD.:

We, as Creditor of the above referenced account, attest that this is a commercial debt which is now due and owing. We assign said debt to you for collection as of the date of this transmission in accordance with established rates.  We authorize you to accept and deposit payment, endorse checks, and other negotiable instruments, and to execute Proof of Claim Forms, when necessary.  We authorize you to forward this claim to legal council, as needed and understand that Atwell, Curtis & Brooks, Ltd. may retain as compensation for its costs, all lawful sums collected over and above the principal balance. It is further understood that accounts withdrawn or settled under direction of creditor, are billable in accordance with agency’s established rate schedule.

 
 
 
Atwell Curtis & Brooks



Commercial Collection, Consulting/Auditing,
Consumer/Retail Collections, Accounts Receivable Co-sourcing,
Accounts Receivable Portfolio Liquidation, Credit Recommendations

 

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