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submit an account for collection


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Client name:
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account for collection

debtor:
address:
city:
state:
zip:
phone:
amount due:

please check appropriate boxes:

no response to demand letters:
broken promises of payment:
no answer to phone calls:
no payment since:

please enter any additional information:

please proceed with
10 day free demand:
immediate collection:

1200 Glynn Ave. Suite 11., Brunswick, GA 31520 Phone: 912-554-1284 Fax: 912-554-8034