Submit a Claim To place an account with our firm, please fill out the below form and attached supporting documents in pdf format. Debtor Information: Your Name (required) Amount owed (required) Address (required) City/State/Zip Code Your Email (not required) Phone Contingency % Initials (sales person) Date of Recent Unpaid Invoice Account and/or Invoice # Additional Amounts Name of Individual or Company Responsible (required field) Subject Facts ______________________________ Please provide any of the following information (if applicable); invoices, contracts, bills of lading, insufficient checks, proof of delivery, guarantee, and/or credit applications. Client Information: Name (required field) Address Phone (required field) Authorized By Email (not required) File Upload (not required)