I need to submit an
account for collection.



Collection Services
Main Page


Due Diligence
Report Form




Click on the email
below to send your
claim supporting documents:
andreas@picb-us.com

or

Fax supporting
documents to:
(847) 265-4377
P PROFESSIONAL CREDIT MANAGEMENT ASSOCIATES ACCOUNT PLACEMENT FORM
CLIENT INFORMATION
*COMPANY NAME:
Required.		 STREET ADDRESS:
CITY:
 STATE:
 ZIP:
*CONTACT PERSON:
Required.		 *PHONE: (e.g. 000-000-0000)
Required.Invalid format.		 FAX:
*EMAIL:
Required.Invalid format.
DEBTOR INFORMATION
DEBTOR COMPANY NAME:
 STREET ADDRESS:
CITY:
 STATE:
 ZIP:
CONTACT PERSON:
PHONE:
 MOBILE PHONE:
FAX:
CLAIMED AMOUNT:
$		 DATE DEBT WAS INCURRED:
_ I WILL PROVIDE THE FOLLOWING IN SUPPORT OF OUR CLAIM.
(PLEASE INDICATE ONLY THOSE ITEMS THAT APPLY TO THIS CASE):
STATEMENTS NSF CHECKS WRITTEN QUOTE
IINVOICES CREDIT APPLICATION PERSONAL GUARANTEE
PURCHASE ORDERS CORRESPONDENCE OTHER CONTRACTS
PLEASE INDICATE THE STATEMENT(S) THAT APPLY TO THIS CASE:
IS YOUR DEBTOR OUT OF BUSINESS? PLEASE PROVIDE DETAILS BELOW ABOUT THE DISPUTED CLAIM:
IS MAIL BEING RETURNED?
IS YOUR CLAIM DISPUTED?
THIS CLAIM IS SUBMITTED BY:
NAME:
 TITLE:
 TODAY'S DATE:

BY SUBMITTING THIS CLAIM, YOU AGREE TO THE STATED TERMS AND CONDITIONS
PLEASE READ TERMS AND CONDITIONS BEFORE SUBMIT CLAIM