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Place your overdue accounts

If you’re interested in placing your overdue accounts with us, please fill out the required information below so that Adaptive Recovery can contact you.

Debtor Information

Debtor Company Name (required)

Debtor Address (required)

City/State/Zip (required)

Debtor Phone Number (required)

Customer Reference Number

Debtor Contact

Title

Phone #2/Cell Phone

Addl Contact

Debtor Bank

Principal Amount Owed (required)

Interest

Client Added Fees

Additional Fees

Oldest Unpaid Invoice Date (required)

Most Recent Unpaid Invoice Date

Most Recent Payment Date

Email

Phone

Account #

What Product or Service was Sold? (required)

What was said on the last call / Other details?

Supporting Documentation Available (Check All that Apply)

Invoice Statement Contract Credit Application Personal Guarantee Lien Proof of Delivery NSF Check Purchase Order Bill of Lading

Other

Client Information

(Client) agrees that the debtor company listed above is being referred to Adaptive Recovery Solutions, LLC dba Adaptive Recovery (Agency) to perform collections services and Agency is authorized to proceed at once to collect the amount specified.

Client Name (required)

Client Address (required)

City/State/Zip (required)

Tel (required)

Email (required)

Documentation

Drag your file below or Choose File

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