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  Commercial Claim Placement Form

* Indicates a required field

Debtor Company Information
Company Name  *
Street Address *
City, State, Zip *
Company Phone # * Cell Phone #
Email Address Fax #
Total Amount Due $ * Invoice Date (oldest) *
Customer's Account # FED Tax / Soc Sec #
Name of Contact Title
Customer's Bank Bank Account #
 Debtor History - Please Check All That Apply
               
No Response Check Returned Disputed Mail Returned
Claims Inability To Pay Phone Disconnected  Other 

Please Include Any Additional Information Below in the Comments Box

 
Document Checklist: Please send all information to RSD via email, fax or U.S. Mail
   
Signed Contract/P.O./Credit Application, etc.
Invoice(s) copies
Statement copies
Proof of Delivery/Receipts, etc.
Personal Guarantees, Notes, etc.
Credit report
 
Creditor Information
RSD Client Name * Date
Address
City, State, Zip
Claim Submitted By * Phone # *

Security Validation

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   Type the code into the box on the right so we know this is a legitimate request. 

EXISTING CLIENTS: By submitting your claim for collection, you are agreeing to the terms and conditions as set forth in our client agreement for the type of claim placed whether consumer or commercial. 

NEW CLIENTS: If you are a new client and have not entered into an agreement with our agency, an RSD representative will contact you shortly to review our rates, terms and conditions. Should you have any questions regarding this process, please call us at 1-888-701-8181 and we will be happy to assist you.

 

 

 

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Copyright 2007-2014 Ross, Stuart & Dawson, Inc. All Rights Reserved.

 

Ross, Stuart & Dawson, Inc.

Corporate Office
691 N. Squirrel Rd, Ste 175
Auburn Hills, MI 48326

Tel: 248-370-8160
Fax: 248-370-8165

Toll-free: 1-888-701-8181