Collection Authority Form – Law Debt Collection Limited

My/Our email address is *

Debtors Details… (if not applicable use n/a)

Debtors Full Name

D.O.B

Trading Name

Contact Name

Debtors Address

Debtors P.O. Box

Debtors Telephone

Debtors Mobile

Debtors Fax

Debtors Email Address

Debtors Customer No

Do you have a signed credit application form? *

Is this account in dispute? *

Have you received a letter of dispute from the debtor or the debtor’s agent? *

Do you have the debt recovery clause? *

Please list down supporting documents you have such as quotation, signed agreement, credit application form etc

Amount of debt?

Collection costs can only be added to the debt if you have a signed agreement with the debtor or the debtor is aware of extra costs before the job is done if not paid on time. YOU CANNOT ADD COLLECTION COSTS TO THE INVOICE AFTER THE WORK HAS BEEN COMPLETED.

Commission to be added to debt? *

Please list down supporting documents you have such as quotation, signed agreement, credit application form etc

Collection costs to be added? *

Please list down supporting documents you have such as quotation, signed agreement, credit application form etc

Can you post/fax/email copy of statements or invoices to us? *

Amount owing?

Date (as per statement)

Since Paid?

Date

Balance owing

Date

Do you require – Debt Recovery? *

Do you require – Tracing? *

Do you require – Agents Visit? *

Do you require – Legal Action? *

Client Authorisation Part 1… (if not applicable use n/a)

Client Name

Contact

Client No

Date

Collection Officer

Special Comments

Collection costs can only be added to the debt if you have a signed agreement with the debtor or the debtor is aware of extra costs before the job is done if not paid on time (terms of trade). You cannot add collection costs to an invoice after the work has been completed unless you have signed terms of trade.

Client Authorisation Part 2… (type your name in the box)

I/We authorise Law Debt Collection to act as our agents in the recovery of all debt collection matters and agree to pay all commission and costs in accordance with the Terms Of Engagement completed

Name of person completing this form

Email Address of person completing this form

Upload Supporting Documents

Drop your file here or click here to upload You can upload up to 10 files.