Customer Claim Placement

Place a Claim Online
  • Debtor / Customer Name*
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  • Address*
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  • City/State/Zip*
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  • All Phone Numbers*
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  • Your Acct # for this Customer*
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  • Contact Name(s)*
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  • Merchandise Sold /Service Provided*
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  • Date of Oldest Open Invoice*
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  • Total Balance to Collect*
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  • Fax*
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  • Email*a valid email address
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  • Files*upload files hereUpload
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    • Additional Info or Comments*
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    • YOUR COMPANY INFORMATION
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    • Your Company Name*
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    • Your Mailing Address*
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    • Your Contact Numbers*
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    • Your Email*a valid email address
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    • Authorized by:*
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    • Today's Date*
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    • 20

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