(248) 370-8160 (888) 701-8181 Pay Online Place a Claim

Place a Claim

Debtor Company Name*
Debtor Street Address*
Debtor Suite, Apt #, Floor, Etc.
Debtor City*
Debtor State
Debtor ZIP / Postal Code*
Debtor Phone*
Debtor Cell Phone
Debtor Fax Number
Debtor Email Address*
Debtor's Account Number*
Debtor Total Amount Due*
Debtor Invoice Due Date (Oldest)*
Debtor FED Tax #*
Debtor Contact Name*
Debtor Contact Title*
Debtor Bank Name
Debtor History -- Check All That Apply Claims Inability to Pay Mail Returned Disputed Check Returned No Response Phone Disconnected
Additional Information / Comments
Document Checklist (Please send all documents to RSD via email, fax, or US Mail) Personal Guarantees, Notes, Etc. Proof of Delivery / Receipts Statement Copies Invoice(s) Copies Credit Report Signed Contract / P.O. /
Credit Applications, etc.
RSD Client Name*
Claim Submitted By*
Street Address*
Suite, Apt #, Floor, Etc.
City*
State*
ZIP / Postal Code*
Phone*
Email Address*

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.

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.